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DOE-STD-1045-93
investigation is appropriate for all events, conditions, "near misses," or other indications
of situations within or outside the operations organization that, if uncorrected, can
impact safety or reliability. Acts of actual or suspected sabotage represent a special case
for investigation.
The investigative process described in this guide is intended to assist the operating
organization in evaluating and responding to operational abnormalities. These
investigations are not intended to replace the formal Type A, B, or C investigations that
are required for certain occurrences in accordance with DOE Order 5484.1,
Environmental Protection, Safety, and Health Protection Information Reporting
Requirements, although both investigations have similar objectives. Consider again the
situation of a supervisor immediately after a serious operating event. Even though
immediate actions have been taken in accordance with appropriate procedures, the event
may still impact personnel or facility safety. Therefore, it is important that the
operations organization begin the investigative process as soon as possible.
To ensure consistency, facilities should provide written guidelines to address all aspects
of the investigative process. Concise instructions will aid the supervisor in properly
collecting and/or preserving physical evidence that may be needed in the investigation.
Standard forms, or an example format, will aid in documenting statements from the
personnel present during the event. Checklists may be useful for ensuring that all
appropriate operating records (e.g., recorder charts, round sheets, logs) are collected or
copied for use in the investigation. Finally, clear instructions for conducting the
investigation will make effective use of time and will aid personnel in evaluating the
corrective actions taken and the results of those actions. This process will enable
personnel to determine the current safety status of the facility and the capability for
continued operation.
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