DI-MGMT-82188
Accident Incident Report
The Accident Incident Report notifies the government of accidental, non-routine incidents involving personnel injury, property damage, security violations, or other significant incidents.
Approval DateMarch 22, 2018
AMSC NumberN9905
Preparing ActivitySH
Project NumberMGMT-2018-018
OPR—
DTIC Applicable—
GIDEP Applicable—
Limitation—
Applicable Forms—
Approval Limitation—
Form Version—
DID Formatfree_text
963C CompliantYes
DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.
Application & Interrelationship
—
Use & Relationship
The Accident Incident Report provides the government with notification of incidents that happen accidentally, are not in the usual course of operations, are not according to expectations, and are not routine. The report covers incidents resulting in any one or more of the following: personnel injury, property damage, security violation, or other significant incidents.
This data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.
Preparation Instructions
1Format.The report shall be presented in a format similar to that in Figure 1.
2Content.The report shall contain all of the information in Part 1 through Part 4 of Figure 1.
2.1The Report shall identify incidents resulting in any one or more of the following:
2.1.1Personnel InjuryAny incident that involves injury that could result in loss of time from work and requires medical treatment beyond first aid.
2.1.2Property Damage or Loss
2.1.2.1All property damage or loss regardless of dollar value.
2.1.2.2Any accident that involves vehicle damage or property damage caused by a vehicle.
2.1.3Security Violation / Incident
2.1.3.1Any incident involving protection of Tactical Training Range facilities, computer networks, or computer environments.
2.1.3.2Any incident that involves the loss, compromise, or suspected compromise of classified or sensitive information.
2.1.3.3Any incident that involves unauthorized changes to the Information Assurance posture of a computer network as defined in the respective SSAA will be considered a violation.
2.1.4.1Any incident the submitter is unable to resolve under the three other categories.
2.1.4.2Any incident that occurs on the range where the Contract Site Manager (CSM) or Range System Manager (RSM) determine that an Accident/Incident Report is warranted to preclude a similar occurrence on the Combined Tactical Training Ranges (CTTR).
2.2A summary of what happened in the incidentA summary of what happened in the incident shall be included.
2.3The events preceding the investigationThe events preceding the investigation shall be specified in reverse order of occurrence, starting with the event and moving backward in time. A reconstruction of the steps that led to the investigation shall also be included.
2.4Causal factors of the chain of events leading to the accident or incidentCausal factors of the chain of events leading to the accident or incident shall be included.
2.5Actions and corrective actions to prevent re-occurrenceThe report shall include actions and corrective actions that have been or will be taken to prevent re-occurrence, the timeframe for performing all actions and corrective actions, as well as the associated work order that will be used to track cost.
Figures
Figure 1. Figure 1 - Accident/Incident Report (Sample)
Figure 1 (continued). Figure 1 - Accident/Incident Report (Sample) (continued, Part 4)
Schema v3.0Community-maintained · Verify against ASSIST 