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Copaii train the supervisor module 09.27.10
- 1. C ity O f P hiladelphia A ccident, I njury & I llness Report City of Philadelphia Office of Finance Risk Mgmt. Division COPA II
- 3. COPA II – Information/Specifics & Fundamental Cause
- 14. Example: Part 1
- 15. Part II: Description of Incident
- 19. Example: Part 2
- 20. Part III: Motor Vehicle Accidents/Crash
- 22. Part IV: Signatures & Date
- 24. Part V: Fundamental Cause & Corrective Action
- 26. Example: Part 5
- 29. Example: Part 5
- 31. Fundamental Causes? (Give the letters) What are the Correction Action?
- 32. QUESTIONS?
Editor's Notes
- Introduce yourself and the training subject. Example: “Today we are going to provide you with training on completing the City’s Accident, Injury, and Illness report form, otherwise referred to as COPA II. This is the injury/illness report form is being used City wide for all departments.” Make sure they know who the Departmental Safety Officer is and provide contact information.
- This is the COPA II form. (Hold up the form) Monthly reports that document the status of all COPA II forms that were or should have been submitted are being provided the Departmental Safety Officer, Commissioners, & Deputy Commissioners of all departments. These reports document the status & any delays of all COPA II forms that were or should have been submitted. Has a COPA II been submitted for an injury claim? Has the back of the form been completed? First Report of Injury Delay (Days from Date of Injury until you reported it to CSI, not necessarily via COPA II) COPA II Lag (Days from First Report of Injury to COPA II submitted) The information on the COPA II forms are used to determine the top injury causes for the department and help determine things such as work relatedness.
- Employees who incur an injury or illness as a direct result of their job responsibilities, must report the injury to their immediate supervisor. Employees exposed to communicable disease should contact the depts. Exposure Control Officer (Give name & contact info if applicable) and follow SOPs. Employees who need medical treatment must obtain a referral slip for evaluation from their supervisor and be treated at a City Medical Provider (CMP) site. Show the referral slip. The referral slip must be obtained prior to treatment at a CMP. For instances when emergency treatment is needed, do not delay treatment waiting for a referral slip. Get the employee to an emergency treatment facility ASAP. Handle the referral slip ASAP.
- Supervisors must report injuries to the City’s third party administrator immediately at the number provided. *** In some departments, supervisors are required to forward information to the safety office and the Safety Office will be responsible for reporting the injury to the TPA. *** The COPA II report must be completed and submitted to the departmental safety office within 48 hours of an employee’s injury. *** Some departments require an injury/illness report to be submitted within 24 hours ***
- The supervisor on duty at the time of the incident is the individual responsible for completing the report (The supervisor on duty at the time of the incident will know more about the assign the employee was given and the circumstances surrounding it.), but should do so with feedback from the injured employee. The employee is not to complete the form. COPA II should be completed at the time of the incident or as soon as safely possible.. Obtaining immediate medical attention for the affected employee and controlling/eliminating the hazard that contributed to the injury/illness is first and most important. If the employee is getting treated or is otherwise unavailable, complete the form with as much information as possible and notify the dept. safety office. All sections of the report should be completed to the best of your abilitiy. Address & complete all areas of the report.
- The report is divided into five (5) parts. Each part is separated by a bold line and the title for that part is shaded. The form is a PDF. You can complete the form using any level of Adobe Acrobat but you will not be able to save the completed document electronically using Reader. You can save the completed form if you are using the more advanced versions of Acrobat. No matter which version you use, you have to print the document & fax or mail it to CSI.
- Part I – Collects information about the Who, When, & Where.
- It is important to get the full first & last name. Some people go by nicknames, such as Jack instead of John, or by their middle name, C. Thomas Howell. Be sure to get the CURRENT information from the employee. The City may not have updated the employee’s job or contact information in the computer files. Many people have moved multiple time during their career with the City and the information may not be updated. Telephone Numbers Obtain the employee’s work telephone number If the employee does not have a work number, the telephone number of the employee’s NORMAL supervisor should be in inserted Obtain the employee’s home &/or mobile phone numbers if possible Employee’s are not required to provide home & mobile telephone numbers The Payroll Number is located on the employee’s City ID.
- Hand out “Occupational Safety and Health Definitions” sheet Injuries include incidents involving broken bones, strains, sprains, cuts, etc. Illnesses include skin diseases such as contact dermatitis, respiratory conditions such as asbestos, poisoning such as carbon monoxide poisoning, hearing loss, & exposure to diseases such as Hepatitis B or C Near misses are instances when an injury could have happened but didn’t such as when an employee trip & falls over an extension cord but is not injured or an auto accident with no injuries.
- Job Title is the employee’s typical job title. Job Title at time of injury is the title of the job being performed at the time of injury regardless of the employee’s normal job title. These job titles may be the same or they may be different. If they are the same, enter the same job title in both sections. Do not enter “Same” in the Job Title at Time of Injury section. Non-routine is either “out of job class” or not everyday job. Example of a not everyday job is erecting the Christmas Tree at City Hall each year. The Immediate Supervisor is the employee’s normal day to day supervisor. The Immediate Supervisor at the time of the Injury is the person supervising the employee when they were injured. The Immediate Supervisor & the Immediate Supervisor at the Time of the Injury may be the same person. If so, place the same name in both blocks. Do not enter “same” in the Immediate Supervisor at the Time of the Injury section. Witnesses: Gather as much information from the witnesses as possible. This information is frequently left blank or incomplete. The contact information should be completed for all witnesses. If there are no witnesses, that should be noted in the block.
- Complete the incident where & when information. If the incident occurred inside a building, complete sections 24 – 26 – Leave sections 27 – 29 blank Complete sections 27 – 29 if the incident occurred outside – Leave sections 24 – 26 blank Section 28 – provide closest intersection if possible or universal identifier if an intersection or address are not available. The location and time can assist in determining root cause. Was it outside in January? If so, you might ask if there was snow or ice. Was it inside? If so, you might ask if there was enough light.
- Is this part completed correctly? Box 1 - Is “Gil” the persons full first name? Box 2 – The house number is missing. Box 15 – Witness #1’s contact info is missing. Boxes 16 & 18 – The injury was reported over 2 months after it occurred. Why? Employee didn’t report it or Supervisor didn’t report it.
- Part II – Collects information on the incident & what happened.
- This block is frequently completed incorrectly. This information is used when determining the Top Injury Causes for your department. If you correctly complete this section, your Safety Officer can have some support information to change process or possibly equipment. Check only the most appropriate accident type ( select only 1 ) “ Other” should be used sparingly. Very few accident type will be classified as other. If “Other” is checked you must provide a description of the accident type. Checking multiple causes or other when it’s not appropriate may change the top causes determination.
- This block in incorrectly completed or left blank nearly 50% of the time. Check all body parts that were injured. Indicate where each body part was injured F – Front B – Back L – Left R - Right “ Other” should be used sparingly. Very few “Body Parts” will be classified as other. If “Other” is checked you must provide a description of the body part & where the body parts was injured If there were claims in your area that involving overexertion but no body parts are identified, we wouldn’t be able to identify what is happening.
- Inadequate or incomplete descriptions may hinder the safety efforts to reduce the hazards related to the incident in question. If we’re not sure what happened how can we fix it? Provide a detailed description of the incident. Talk with employee to obtain and describe the actions of employee at the time of injury, the type of accident, describe how the injury was sustained, identify specific body parts injured, and indicate any involvement with/from other individuals contributing to the injury. Use additional sheets if needed. Include information from the witnesses & note any environmental issues that may have contributed to the incident. We can’t get information such as “there was water on the floor” 2 months later. Provide supervisors with the list of CMP or location of the CMP list if it is posted. List the highest level of medical treatment given. If first aid was provided & the employee was treated at a CMP, then check the CMP & leave the first aid block unchecked. If seen at one of the CMP sites, write in the name of the clinic. If seen outside of the City’s network for initial treatment because of emergencies or nights/weekends, write in the name of that facility.
- Is Part 2 complete? Boxes 31 & 32 – The description (Box 32) mentions the upper leg pain but Box 31 fails to list the legs as a body part injured. Box 32 – The incident occurred outside but does not provide the weather conditions at the time of the incident. Was it wet or hot?
- Collects information on Police report numbers (the District Control Number & Accident Investigation Division (AID) number) & the City vehicle involved. Leave sections 34 – 36 blank if there was not a vehicle was not involved
- This section should be filled out if the injury was a result of a vehicular crash. Get the D.C. (District Control) number from Police, A.I.D. (Accident Investigation Division) number, if Police A.I.D. conducted an investigation, and the City vehicle property number involved. Even if the Police do not come out to the accident site, there should still be a D.C. number for the accident. Call the District station to get the D.C. number. If the Police do not come out to the scene there should still be a DC number for the accident. Contact the district where the accident occurred directly for the DC number. You can get the District number where the accident occurred by going to http://www.phillypolice.com/districts and typing in the address of the accident. The Vehicle property number is often missing. It is important to get the property number so that maintenance records can be pulled or further investigation can be completed when questions arise. Don’t forget to complete the Traffic Accident Report - City Vehicle form (2-S-87) in addition this COPA II report. Provide supervisors with Traffic Accident Report - City Vehicle form (2-S-87) if they are responsible for completing this form in your dept.
- Part IV – Verifies that the interested parties have reviewed the COPA II form.
- Employees are required to sign the COPA II. Signing the form indicates that they have seen & reviewed the form. It does not indicate that they agree with all statements made on the form. If employee refuses to sign the form, the supervisor shall indicate that fact in the employee signature block & initial it. The immediate supervisor on duty at the time of the injury must sign the form The Unit Supervisor is the immediate supervisor’s (your) supervisor. Send the COPA II to the Departmental Safety Officer for their signature. Section 45 is for DC 47 employees only . By initialing section 45, the DC 47employee authorizes the release of the information contained in the COPA II to the Health & Safety Officer of the DC 47 Health & Welfare Fund. DC 47 members are not required to initial it but must be given the opportunity to do so. There is no such agreement with the DC 3#, IAFF, or the FOP.
- Part V – assists the supervisor (you) & Safety Officer in identifying the root cause of the accident & possible avenue for corrective actions. There may be concerns about disciplinary action because of findings from the report form. If the employee’s action was blatantly wrong, then the supervisor would take disciplinary actions via normal supervision and personnel involvement regardless of this report.
- This is the section is frequently misunderstood. Review the root causes column & then the possible corrective actions column. Don’t assume they understand. Utilize COPA II’s from your dept to illustrate mistakes and proper responses. Think about the incident and what was the root cause. Be specific on what should be corrected. Try to refrain from general phrases. For example do not state “be more aware of your surroundings”. There may be concerns about disciplinary action because of findings from the report form. If the employee’s action was blatantly wrong, then the supervisor would take disciplinary actions via normal supervision and personnel involvement regardless of this report.
- Use the “Possible Corrective Actions” (right hand) column for guidance on how to address identified root causes (left hand column). Address all root causes identified Statements such as “the employee needs to be more aware of their surroundings” or “nothing could have been done” do not address the root cause of the incident. List all recommended corrective actions in Section 47. These will include immediately implemented, short term, & long term recommendations Use the photo in the slide as an example of a fall. What is/are the fundamental cause(s)? What are possible corrective actions?
- Take this incident for an example. A worker, who drives a large truck, parks on the side of the road to start the job. When he gets out of the truck he steps on the curb and twists his ankle. Don’t say “be more aware of your surrounding”. There could be 2 corrective actions. One is to train the employee on 3 points of contact (2 feet and a hand, two hands and a foot) when exiting the truck. The second could be to install hand holds on the trucks to assist workers exiting the truck.
- The immediate or unit supervisor (depending on your department, division, or unit structure) will recommend actions to take to prevent the conditions checked in section 46 that may aid in preventing a future incident. The person filling out this section will depend upon whose administrative responsibility it will be to make sure corrective actions are instituted. Provide the date the recommendation(s) in section 47 were implemented. The form should not be considered truly complete until this section is completed and forwarded to the departmental safety office. Initially the form may be absent of this date, but follow-up should continue until the form is complete. Forward a fax or hard copy to the departmental safety office or call and provide them with the date for the respective employee’s COPA II report form.
- Equipment: C: THE CORRECT EQUIPMENT, TOOLS, OR MATERIALS WERE NOT USED OR WERE NOT READILY AVAILABLE. D: SUBSTITUTE EQUIPMENT, TOOLS, OR MATERIALS WERE USED IN PLACE OF CORRECT ONES. Environment: G: THE LOCATION/POSITION OF EQUIPMENT/MATERIAL/EMPLOYEE CONTRIBUTED TO THE HAZARDOUS CONDITION. People: K: THERE ARE NO WRITTEN OR KNOWN PROCEDURES OR RULES FOR THIS JOB. N: THERE WAS A FAILURE TO DETECT OR CORRECT DEVIATIONS FROM JOB PROCEDURE. O: EMPLOYEE DID NOT KNOW THE JOB PROCEDURE OR THE EMPLOYEE DEVIATED FROM KNOWN JOB INSTRUCTIONS. S: INDIVIDUALS WERE NOT ADEQUATELY TRAINED IN ACCIDENT PREVENTION AND AWARENESS. T: INADEQUATE ENGINEERING, MAINTENANCE, OR WORK STANDARDS CONTRIBUTED TO THIS INCIDENT. PPE: None