ES&H Manual



5200 Appendix T1: Occurrence Reporting Procedure



1.0           Purpose


Jefferson Lab notifies the Department of Energy (DOE) - Thomas Jefferson Site Office (TJSO) of any occurrence that could adversely affect the health and safety of the public, its workers, and the environment. Occurrence reporting promotes organizational learning consistent with DOE’s Integrated Safety Management System goal of enhancing mission safety and sharing effective practices to support continuous improvement and adaptation to change.


2.0           Scope


This procedure is applicable to all notable events and near misses including subcontractor activities.


3.0           Responsibilities


3.1            Everyone at Jefferson Lab

When an event resulted in injury to personnel, follow the process steps outlined in ES&H Manual 6800 Appendix T2 Injuries and Illnesses Requiring First Aid or Emergency Medical Response.


3.2            Involved Persons

·       Place the area in a safe condition and secure the scene.

·       Report any event to your supervisor/Technical Representative/sponsor and security as soon as possible. This includes events that occurred offsite on job related business.


3.3            Supervisor/Technical Representative/Sponsor, Occupational Medicine

·       Secure affected area/equipment (this may include cordoning off the area and taking preliminary photographs). Ensure the scene is preserved pending the investigation.

·       Notify the ES&H Reporting Officer (cell-757-876-1750), Division Safety Officer, and Director/Associate Director/Division Manager.


3.4            ES&H Reporting Officer (RO) or ES&H Director

·       Notify the ES&H Director, Performance Assurance, appropriate Division Safety Officer and appropriate Division Manager(s) of the event

§  The ES&H Director will notify the Laboratory Director and Chief Operating Officer

·       Perform Occurrence Reporting Activities

·       Arrange and attend the Preliminary Event Meeting.

·       Initiate a Notable Event Report Form


4.0           Process Steps


4.1            Occurrence Reporting Activities

·       Make an initial determination that the incident is a notable event using ES&H Manual Chapter 5200

·       Use DOE O 232.2A to determine the unofficial category of the event as Occurrence Reporting and Processing System (ORPS)/ Noncompliance Tracking System (NTS)/ and Occupational Safety and Health Administration (OSHA) 300 form to determine if the event is Computerized Accident Incident Reporting Systems (CAIRS) Reportable

·       Verbally notify ES&H Director or designee to confirm determination categorization is appropriate

·       Modify if needed, and then verbally notify the impacted Division Safety Officer (DSO), Performance Assurance (PA) and the Thomas Jefferson Site Office (TJSO)


Note: Notable Event decision should be joint between the Reporting Officer and Performance Assurance with regards to Management Concerns.


4.2            Preliminary Event Meeting


The ES&H RO schedules a Preliminary Event meeting and invites both the required and optional attendees. The purpose of the meeting is to determine what happened, timeline of occurrence, which employees were involved, and to develop a plan for further investigation.  


Record notes on the Preliminary Event meeting form and attached to the Notable Event form within the database


Step 1 – Invitation


·       Schedule and attend the Preliminary Event meeting within 24 hours at or near the location of the event (if possible). PA will lead the Preliminary Event meeting and the ES&H RO will complete the notable event form and take minutes


o   Required Attendees

§  ES&H RO or their designate

§  Performance Assurance Manager or their designee (Chair)

§  Supervisor/Line Manager of the directly involved person(s)

§  Subject Matter Expert (SME)

§  Division Safety Officer (DSO)

§  The involved person(s) and/or those directly impacted by the event – send a Witness Account Statements and ask that they complete it and bring it to the meeting.


Note: The person(s) directly involved may not be able to attend due to injury or illness. If this is the case, the lead investigator determines if a separate interview or discussion is acceptable.


§  Witnesses to the event (only pertinent personnel are required to attend) – send a Witness Account Statements and ask that they complete it and bring it to the meeting.


o   Optional Attendees (at a minimum, notification is provided)

§  Associate Director/Division Manager

§  TJSO Representative (as an investigation observer)

§  Other management e.g. Area Manager


4.3            Notable Event Form


To maintain consistent information throughout the process, the ES&H RO initiates the Notable Event Form to record as soon as possible following the Preliminary Event Meeting:


·       Event Title

·       Responsible Owner

·       Category of Event

·       Event Location

·       Date of Occurrence

·       Time of Occurrence

·       Date the Notable Event Report is Due

·       Time the Notable Event Report is Due

·       Short Summary of the Event and/or Injury(ies)

·       Attach all minutes, notes, witness statements and other relevant information

·       Occurrence Reporting and Processing System(ORPS) Entry Number

·       Non Compliance Tracking System (NTS) Registration and Reporting Entry Number

·       Computerized Accident Incident Reporting Systems (CAIRS) Entry Number


5.0           Official Notifications


1.         Email the official ORPS/NTS/CAIRS determination to TJSO and cc: ES&H Director, DSO and PA

*If this event involves a potential injury, RO must also reply to the Occupational Medicine email

2.         Develop the Safety Flash and send for review within two days or less of the event.

a.   Send the draft Safety Flash to the subject matter expert that attended the Preliminary Event and then send it to the ES&H Director for review and comment. 

b.   Once ES&H Director is done, if there are any technical detail changes made to the Safety Flash, it should be reviewed by the SME again

c.   After that, the Safety Flash enter into Mail Chimp and send to Public Affairs for review.

d.   Once Public Affairs has reviewed the Safety Flash the RO will schedule it to be sent and

e.   Once sent, pdf the safety flash and archive it on docushare


6.0           DOE Database entry


1.               Enter the report(s) into the corresponding DOE database within the allotted timeframe.  The initial report for ORPS is due within two days of the determination, the CAIRS report is due within seven days of the event and the final ORPS report is due within forty-five days of the event.  Enter all NTS entries once the notable event report is finalized. There is no specific timeframe for NTS.

2.               Send the draft report to the ES&H Director and the TJSO counterpart for review and feedback.  Be sure to notify them of your deadline in the corresponding database.

3.               Once feedback is received and incorporated into the report, then submit the report

a.                Follow steps one and two above for both the initial and final reports (ORPS)



8.0     Revision Summary  

Revision 3.1 – 09/26/23 –  Changed process approval, minor edits. No approved needed.

Revision 3.0 – 10/26/21 –  Updated title to Occurrence Reporting Procedure.  Removed content for event investigation these responsibilities have been delegated to the Performance Assurance Department and are provided in ES&H Manual Chapter 5200T2. Approved chapter was not posted until database was live. Procedure posted on 1/10/22. Approved by S. Hoey and S. Henderson

Revision 2.0 – 05/29/19 – Periodic Review; updated Purpose, Scope, and Process Steps to align with HPI initiatives and concepts

Revision 1.6 – 05/20/17 – Periodic Review; extended 1-year per TPOC due to anticipated changes regarding this process

Revision 1.5 – 10/04/13 – Changed COE to Lessons Learned; updated process for Lessons Learned Coordinator to reflect current laboratory operations

Revision 1.4 – 09/06/12 – Qualifying Periodic Review; clarification of content only

Revision 1.3 – 01/31/12 – Updated ESH&Q Reporting Officer assignment from Smith to Johnson per M Logue

Revision 1.2 – 08/12/11 – Recognized that recommendations for corrective/preventive actions are to be documented in CATS

Revision 1.1 – 06/24/11 – Edited to clarify process steps

Revision 1.0 – 10/19/09 – Updated to reflect current laboratory operations










ES&H Division

Tina Johnson





This document is controlled as an on-line file.  It may be printed but the print copy is not a controlled document.  It is the user’s responsibility to ensure that the document is the same revision as the current on-line file.  This copy was printed on 10/5/2023.