Accident and Near Miss Reporting

Policy Key Points

An accident is an unintended event resulting in injury, occupational illness, or property damage.
A near-miss (near-hit) is an unplanned event that did not result in injury, illness, or damage, but had the potential to do so under different circumstances.
All incidents must be immediately reported to the supervisor or management.
Supervisors must submit the First Report of Incident form to HR and EHS within 4 hours of notification.
Affected associates must complete the Associate Statement of Incident as soon as medically able (medical attention is priority #1).
Witnesses must complete the Incident Witness Statement.
Light Duty will be accommodated unless doing so poses a safety risk to the associate or others.
All incidents are investigated based on potential severity rather than actual outcome.

Policy

Incident Reporting

Types of Incidents that Require a First Report of Incident Form:

Any injury or occupational illness, regardless of severity.
Any property damage involving:
- Powered Industrial Vehicles (forklifts, order pickers, powered pallet jacks, man-lifts)
- Lifting Equipment (cranes, hoists, rigging, Bishimon lifts, Big Joe's)
- Electrical Test Equipment
- Machinery
- Structural Components of the facility
- Structural Components of Warehouse Racking
- Any property damage in excess of $100 (excluding quality defects utilizing Nonconforming Material tags)
Any Near Miss:
- An unplanned event that had potential for injury, illness, or damage, but where a break in the chain of events prevented harm.
- NOTE: Unsafe conditions or behaviors must be reported, but alone do not constitute a near-miss unless a hazard event occurred.
The following observations must be immediately corrected, reported to management, and documented via a First Report of Incident form:
- Unsafe act on or around a powered industrial vehicle
- Unsafe act around electrical power
- Unsafe act on or around machinery (e.g., removing a machine guard)

Light Duty Program

Yaskawa America, Inc. is committed to supporting the recovery and well-being of associates who experience work-related injuries or illnesses. As part of our Incident Reporting and Injury Management process, the Light Duty Program is designed to facilitate the timely and safe return of injured employees to the workplace.

Light duty assignments will be provided to associates with temporary work restrictions, unless doing so would pose a safety hazard to the associate or others. These assignments may involve modifying existing duties or temporarily reassigning the associate to tasks that align with their current capabilities as defined by a medical professional. Denying light duty must be approved by the VP of Human Resources, the VP of Operations, or the Director of Human Resources.

Benefits of the Light Duty Program

Promotes recovery and engagement: Remaining active in the workplace supports physical and psychological recovery by keeping associates connected to their work environment. Workers who attempt to recuperate at home often have longer recovery times and additional health complications.
Reduces time away from work: Light duty helps minimize lost workdays, supporting operational continuity and employee productivity.
Improves communication: Continued workplace presence encourages better communication between the associate, their supervisor, and EHS/HR representatives.
Maintains team morale: Employees on light duty remain part of the team, reinforcing a culture of care, accountability, and support.

Yaskawa America requires all departments to make reasonable efforts to accommodate light duty whenever medically appropriate and safe. The EHS and HR teams will work closely with supervisors and healthcare providers to ensure appropriate placement and oversight of light duty assignments.

Incident Investigation

Each incident requiring a First Report of Incident form must be investigated. The scale and scope of the investigation shall be appropriate to the consequences and potential consequences of the incident.

Investigations shall include examining factors related to the process, people, material, equipment, environment, and management systems.

The affected associate's immediate supervisor is responsible for completing the First Report of Incident. When unavailable, another member of management must complete it.

When submitted, an automated link is routed to Human Resources, EHS, and the immediate supervisor.

Incident Corrective Action

After reviewing the First Report of Incident form and preliminary findings, EHS or management may require formal corrective action.

Formal corrective action is mandatory for all incidents and near misses that had the potential to result in a Serious Injury or Fatality (SIF).

Incident Corrective Action utilizes an 8-D (Eight Disciplines) methodology:

Identify the Problem
Select the Team
Implement Containment Action
Complete Root Cause Analysis (utilizing disciplined methods such as Ishikawa/Fishbone Diagrams, 5-Why, and Fault Tree Analysis)
Identify Corrective Action
Implement Corrective Action
Verify Corrective Action
Verify Long Term Sustainability (through ongoing audits and reviews)

Associate Rights

Yaskawa America, Inc. encourages the reporting of all safety concerns and incidents. Any form of retaliation against an associate for reporting an injury, illness, or unsafe condition is strictly prohibited.

Records Related to this Policy

Record	Retained by	Retention Time
First Report of Incident and related documents involving an injury or occupational illness	Human Resources	Tenure of employment plus 5-years (30-years for cases involving occupational exposure to hazardous materials)
First Report of Incident and related documents involving property damage	Facilities	Maintained a minimum of 5-years or equipment life (whichever is longer)
First Report of Incident and related documents involving a near miss	EHS Department	5-years (min)
Corrective Action Reports	EHS Department	5-years (min)

Revision History

Rev #	Description	Release Date	Approved by
0	Conversion of old safety documents, rewrite, and issue	4/12/2016	Thurwanger
1	Updated form numbers for Associate and Witness statements	8/24/2017	Thurwanger
2	Updated email link to workcomp@yaskawa.com	2/19/2024	Thurwanger
3	Added "Associates Rights" Section	2/9/2026	Thurwanger

Program Review

Review Date	Reviewed by	Changes Required (Yes/No)	Revision # if updated
2/21/2017	Thurwanger	No	—
1/16/2018	Thurwanger	No	—
1/22/2019	Thurwanger	No	—
1/14/2020	Thurwanger	No	—
1/21/2021	Thurwanger	No	—
1/18/2022	Thurwanger	No	—
1/31/2023	Thurwanger	No	—
1/16/2024	Thurwanger	Yes	2
1/21/2025	Thurwanger	No	—
2/9/2026	Thurwanger	Yes	3

Policy Video

Steps to Complete First Report of Incident Form

The First Report of Incident form should be completed by the affected associate's immediate supervisor or another member of management if the immediate supervisor is not available.
Open the First Report of Incident form.
Supervisor completes the First Report of Incident form then clicks the Submit button.
The submit button sends the form to Human Resources, EHS, & the Affected Associate's Immediate Supervisor.

First Report

Post Treatment

Investigation

Steps in Performing Incident Investigation

1. Collect Statements

Use SAF-F-5002, Associate's Statement of Incident.
Complete as soon as practical (after medical attention).
Use SAF-F-5003, Incident Witness Form for each witness.
Send completed forms to EHS@Yaskawa.com.

2. Analyze the Scene

Review processes, people, material, equipment, environment, and management systems.
Take photos, video, and draw diagrams as needed.

3. Define the Problem

Fully describe the problem that corrective action must resolve.
Note: Defining the problem is distinct from determining the cause (which is addressed during formal 8-D corrective action).