Interview Tool Safe OCS

SafeOCS

INTERVIEW TOOL

Confirmation Number: 0000000000 (mmddyy, 4 random digits)

Incident Number:

Date: ________________

Time of interview: _______ am pm (will be converted to 24 hr format in system)

Interviewer Name: _______________________(this is a BTS employee)

Interviewee Name: _______________________(to be deleted once the interview is completed)

Interviewee Phone Numbers: __________________(to be deleted once the interview is completed)

Received Confirmation Call: Yes  No 

Participating Company:

Reported Before:

Introduction:

Hello, this is (First, Last);

I would like to speak with Mr/Ms (First, Last).

(When you have the person on the line) Hi, (name again), I am a member of the SafeOCS Interview Team located in Washington, DC. You had indicated on your report that this would be a good time to contact you for an interview. (Pause, there may be a response) The interview may take 30-60 minutes; do you have that much time available now?

(If yes, proceed with the interview)

(If no, ask for another time to conduct the interview) When would be the best time to reschedule the interview call? Record Below:

Time: __________________

Date: ________________

Ph #: _________________________

Before we proceed with the interview, I want to provide you with a little background and go over a few ground rules. There is an agreement between the Bureau of Safety and Environmental Enforcement, and the agency I represent, the Bureau of Transportation Statistics, which outlines the benefits of near-miss reporting. The purpose of the project is to gather data related to near-misses that may not be available following traditional incident investigation procedures. The information you are sharing with me will be kept strictly confidential. I will be asking you several questions that initially may seem unrelated to your incident, but the information you will provide is necessary to fully develop the circumstances of the incident, the safety culture environment and provide the summary data which may be useful in identifying the root causes of incidents and, thereby, improve safety.

Proceed with interview –

I have reviewed your near-miss report, but before going into the interview I would like to ask you to give me a verbal account of the incident so I can better understand how the incident occurred.

Description of Incident – Have individual describe the events leading up to including the incident and what happened afterwards. (In their description listen to see if the following are mentioned):

• How long had this crew worked together?

• What kind of harm could have occurred?

• How and when did you communicate safety concerns related to the incident on which you are reporting?

• What was your supervisor’s response?

• What was your follow up on the incident with your supervisor?

• Ask follow up questions to fill-in details to understand the incident and have individual provide explanation of any instructions, procedures or processes referenced.

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Comment field:

Text From Written Report (to be uploaded automatically from the database) –

Oral Report -

Before we begin the interview, would you please share the following information with our research team?

Gender: Male  Female 

Age: _______ (in years)

Height: _______ (feet) _____(inches)

Weight: _______ (in lbs.)

Identify interviewee’s job category:

Work experiences (in years): Oil and Gas Industry_________ Craft ____________

Comments field:

________________________________________________________________________________

Incident information

Date of Incident: Time of Incident: Time Zone:

Incident Type: Incident Category:

Weather: Clear  Cloudy  Fog  Slight Rain  Intense Rain  Snow (on ground)  Snowing 

High Winds  Lightning  Hail Storm  Conditions in Transition  Cold  Hot 

Light Condition: Visibility: Temperature:

3-Day Work/Sleep History Information

(Please use military time (24-Hour clock) for work and sleep periods)

3-Day Work Shift History	Shift Start Time	Incident Time	Shift End Time
Incident Shift Day
Day before Incident
2 Days before Incident
3-Day Sleep History	Sleep Start Time	Sleep End Time	Nap – Yes/No
Last Sleep before Incident Shift
Sleep Period the Day Before
Sleep Period 2 Days Before

Defective Equipment:

• Yes (Describe)

• No

• N/A

When did you become aware of the defective equipment?

• Prior to the incident occurring

• At the time the incident occurred

• After the incident occurred

4. Do you feel that fatigue or lack of alertness contributed to this incident?

• No If no, go to next question.

• Yes Go to drop down box.

Drop down box to collect on fatigue and alertness information:

4a. Did you have trouble sleeping during the 3-days prior to the incident?

• Yes

• No

4b. On a scale of 1-5, with 5 being “the best”, how would you rate yourself on?

4b1.The quality of your sleep during your last rest period (1 - 5):

4b2. How rested you felt when you got up: (1 - 5):

4b3. How alert you felt just prior to the incident (1 - 5):

4c. If you were tired, did you attempt to Lay-Off when called for the incident shift?

• Yes

• No If no, why:

4d. Did you do anything to enhance your alertness prior to this incident?

• No

• Caffeinated beverage

• Stand/walk around

• Eat/Chew something

• Talk

• Fresh air

• Drink/Splash water

• Other (Describe)

5. Were there any issues that affected the quality of your sleep?

• No If no, go to next question.

• Yes Go to drop down box.

Drop down box to collect information on potential issues related to sleeping:

5a. Were they personal?

• Yes

• No

5b. Were they work related?

• Yes If yes, describe:

• No

5c. Have you ever been diagnosed with any type of sleeping disorder?

• Yes

• No

5d. Describe condition:

5e. Describe treatment:

5f. Is the treatment effective?

• Yes

• No

6. Were there any issues that affected your ability to concentrate?

• No If no, go to next question.

• Yes

Drop down box for issues related to ability to concentrate:

6a. Were they personal?

• Yes (no description required)

• No

6b. Were they work related?

• Yes

• No

7. Was the paperwork a problem?

• No If no, go to next question.

• Yes

Drop down box for paperwork issues:

7a. What were the problems with the paperwork?

• Out-of-date

• Inaccessible

• Incomplete

• Not prioritized

• Other (describe)

7b. Did the paperwork problem have an effect on this incident?

• Yes

• No

8. Was a job/safety briefing conducted at the beginning of your shift and/or prior to the incident task?

• No If no, go to next question.

• Yes

Drop down box for job briefing questions:

8a. Who conducted the job briefing?

Job title: __________________________

8b. All members of the crew attended?

• Yes

• No

8c. Discussion of what was to be done and how to do it?

• Yes (Describe)

• No

8d. Did you discuss what might go wrong and what to do then?

• Yes (Describe)

• No

8e. Did you discuss the incident task?

• Yes

• No

8f. Were all questions about the incident task answered and understood?

• Yes

• No

9. On the incident day, did you have any job dissatisfaction issues?

• Yes If yes, describe.

• No

10. How well did the crew getting along? Rate on a scale of 1 to 5, with 5 being “the best”.

Rating: ______

11. Performing assigned duties:

11a. Did you neglect to complete your work correctly?

• Yes If yes, describe.

• No

11b. Did anyone on the crew neglect to complete their assigned duties correctly?

• Yes If yes, describe.

• No

11c. Did anyone else in the working environment neglect to complete their assigned duties correctly?

• Yes If yes, describe.

• No

12. What form of communication was being used during the task just prior to the incident? (Mark all that apply)

• Verbal direct

• Radio

• Hand signals

• Other (Describe)

13. Communication when the incident occurred. (Mark all that apply)

• Verbal direct

• Radio

• Hand signals

• Other (Describe)

14. Was there any confusion or misunderstanding leading up to the incident?

• No If no, go to next question.

• Yes

14a. In your experience, what was the cause of the confusion or misunderstanding?

15. How frequently do you do the incident job or task?

• Several times a shift

• Daily

• Weekly

• Once or twice a month

• Not very often (Ask the subject if he can remember the last time he performed this task.)

16. What rule(s) applied in this incident?

17. Were there any recent changes in the rules or work practices associated with the incident work task?

• Yes If yes, describe.

• No

18. Do you have any suggestions for changes to the rules or practices? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)

• Eliminate

• Revise (Describe)

• Add to the rule or modify the practice (Describe)

• Other (Describe)

19. In your opinion, were any rules violated?

• No If no, go to next question.

• Yes

Drop down box for rules questions:

19a. Why do you think the rules were violated in this manner?

19b. Is this type of rule violation uncommon for you?

20. Can you think of any factors in your work environment that promote or contribute to bending the rules?

• Yes

• No

21. When was the last time you received training on your job or the rules applicable to your job?

Month: __________ Year: __________

21a. When were you certified/recertified? _____________

22. What type of training do you think was most effective for learning you job?

• On-the-job (OJT)

• Classroom

• Simulator

• Some other type of training procedures (Describe)

23. Were there any recent changes at the incident location (equipment configuration, etc.)?

• Yes If yes, describe.

• No

24. Do you think the weather was a factor in the incident?

• Yes If yes, describe.

• No

24a. What were the weather conditions at the time of the incident? (Some typical responses could be: Clear, cloudy, light rain/snow, heavy rain/snow, hot, cold, fog, bright sunlight/moonlight, etc.)

Time of day: (AM/PM and light/dark).

25. Were there any other physical factors (noise, vibration, lighting, walking conditions, etc.) that may have contributed to the incident?

• Yes If yes, describe.

• No

26. Was there any new technology involved with the incident?

• No If no, go to next question.

• Yes

26a. Do you feel that you were sufficiently familiar with equipment or new technology?

• Yes

• No (Describe)

26b. Were you provided any training on the equipment or new technology?

• Yes

• No

27. How safe did you feel working with the other member(s) of your crew?

• Very safe

• Safe

• Slightly safe (Describe)

• Not safe (Describe

28. Was your immediate supervisor aware of the incident?

• No If no, go to next question.

• Yes

28a. In the context of this incident, did your immediate supervisor behave inappropriately in any way?

• Yes (Describe)

• No

29. Is there anything management/company should or could have done to prevent this incident?

• Yes (Describe what they should/could have done:

• No

30. What method(s) does your immediate supervisor use to monitor rules compliance?

31. On a scale of 1 to 5, with 5 being “the best”, how do you rate your immediate supervisor with respect to the following knowledge, skill, and ability factors?

	Ranking (1-5)	Don’t know
General knowledge of operating and safety rules
Building effective relationships with you and your crew
Clear communication of job tasks and instructions
Coaching/Mentoring
Consistent enforcement of rules and requirements
Problem solving

32. What do you do when you see or become aware of an unsafe condition, practice or piece of equipment in your workplace? (Check all that apply.)

• SafeOCS

• Take care of it myself (including coaching other employees)

• Report it directly to a supervisor or manager

• Make a report on the “Safety Hotline”

• Report the matter to the Safety Committee

• File an Unsafe Condition Report with the operator

• Other (Describe)

33. When you have reported safety concerns, does management respond and effectively address your concerns?

• Yes If yes, go to next question.

• No

33a. Did management provide feedback on what would be done to address your safety concern?

• Yes

If yes, how was feedback provided?

• No

34. Do you think your immediate supervisors are generally helpful and supportive of your safety concerns?

• Yes

• No (Describe)

35. How would you rate the effectiveness of communication processes for resolving safety concerns?

• Very effective

• Moderately effective

• Slightly effective (Describe)

• Not effective (Describe)

36. How would you describe the relationship between management and labor at your work location? (Ask for an explanation for why.)

• Just

• Both

• Blame

We are just about finished with the interview; just two more questions.

37. In your opinion, what prevented this from becoming or causing a more serious incident?

38. Is there anything that could have been done differently to have prevented this incident?

39. This space is reserved for the interviewer to comment on the level of risk associated with this incident with respect to: (H = High, M = Moderate, L = Low)

• The people (employees) directly involved in the incident H M L

• Other employees H M L

• Public Safety H M L

• Damage to equipment and/or property H M L

• The environment H M L

End of Interview

Form No: BTS-0031 Page 5