| |
Use grid or graph paper, if available, to help draw to
scale. Mark sketches or diagrams aboard ships showing
forward and aft, port and starboard, compartment
number, or frame number. Ashore, mark magnetic north
or place north in the upper left corner. Use key
landmarks or features to orient your drawing. Mark key
points, distances, and movement on a spare navigation
chart or map. Remember to be as accurate as possible.
Some items to record and measure include the
following:
Location of injured and dead personnel
Machines and equipment affected by the mishap
Parts broken off or detached from the equipment
Objects damaged, marked, or struck against
Gouges, scratches, dents, or paint smears
Tracks or similar indications of movement
Defects or irregularities
Accumulations of stains or fluids
Spilled or contaminated substances
Areas of debris
Sources of possible distractions or adverse
environmental conditions
Safety devices and equipment
Positions of people and witnesses
Possible movement of people, before, during, or
after a mishap
Look for things that are obviously missing. A key
part of a machine may not have been replaced during
maintenance.
Using Various Types of Witnesses
We usually think of witnesses as being people who
were at or near the mishap scene who can provide
helpful information. But witnesses need not be human.
A witness can be anything or anyone who provides
insight into a mishap. A witness may not have even been
near the mishap but can provide information about
events leading up to the mishap. Some mishap
investigation courses identify four types of witnesses,
known as the four Ps: people, parts, position, and
paper.
People. People can include others besides
eyewitnesses, participants, and victims. They can
be your friends, supervisors, or anyone who can
provide information about the mishap. They can
also be technical representatives for equipment
or aircraft involved in the mishap.
Parts. Parts include debris, wreckage, charred
wood, failed machinery, support equipment, or
stressed metals found at the mishap site.
Position. Position includes the mishap location,
patterns of movement, where victims were
found, and where the wreckage was found or was
resting after the mishap.
Paper. Paper, such as logs, records, reports,
drawings, and recordings, provides witnessing
information. Although we may not think of them
as paper-type products, floppy disks also fall into
this category.
All of these items testify about the mishap. But
by far the most valuable information about how the
mishap occurred comes from the human witness.
In a JAG Manual investigation or any other legal
investigation, the investigator is interested in the truth.
Witnesses must swear under oath that their testimony is
true. The written testimony of witnesses, which can be
used against them, must stand up in court.
Witnesses are sometimes reluctant to fully
cooperate in legal investigations because they fear
retribution. That inhibits investigators from getting all
the pertinent information.
A safety investigation cannot risk the withholding
of information! Therefore, witness testimony in a safety
investigation is NEVER TAKEN UNDER OATH! The
safety investigator and witness must share a free and
open flow of truthful information. Witnesses must be
confident that what they say will not be used against
them in any disciplinary or administrative proceeding.
Witnesses must feel free to share rumors; their opinions,
thoughts, or recommendations; or any other information
about the mishap. They must understand that the only
purpose for the information is SAFETY and that
investigators need to know everything about the mishap
to prevent recurrence.
Safety officers, safety petty officers, or safety
supervisors who conduct an informal investigation may
take oral testimony. Although you may take notes, be
careful to avoid documenting any information that may
be used to harm witnesses or their command. For a
4-11
|