FPI Prevention Program
Target the Worst, Protect the Best
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Why FPI Prevention program
Case 1 – Lost time Injury
An employee who takes care of the kitchen in the social area in an office suffered a laceration to her right hand while trying to open
a glass jar of honey. The air-tight glass jar broke apart while she was attempting to remove the screw cap resulting in the broken
glass causing a laceration in the arch of her right hand
The IP was declared not fit to return to work next day as a result of her injury and was declared as LTI.
Entire Top management at that time was aware of this incident as it impacted key metrics
Imagine the same activity repeated for another 10 times, will it change the outcome ? (most Probably the same maximum consequence of LTI)
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Why FPI Prevention program
Play this Video
Case 2 – Observation – Unsafe act
A worker was performing maintenance job on a DTH machine at around 10 meters
without any fall prevention controls in place
HSE Officer approached and asked the workers to come down
Worker did a Tarzan Move and came down
Reported this incident as a HSE Observation – Unsafe act
Disciplinary action was taken on the worker – Removed from the site
As the case was not reported as Near miss or an accident, site management is not
aware of this high potential consequence event.
Imagine the same activity repeated for another 10 times, will it change the outcome
? (most Probably could have resulted in fatality)
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Motivation
The rate of OSHA-recordable injuries declined in the electric utility sector by approximately
50% over the past decade while the rate of fatal injuries has remained relatively stable.
What hurts people isn’t always the same as what kills people…
Defining FPI
Fatality: A fatality is a death resulting from a work-related injury, regardless of the time scale between injury and death.
A Permanent Impairment injury, known as a permanent disability or permanent impairment,
refers to a type of injury that results in lasting or irreversible damage to a person's body or health.
Permanent Impairment injury A direct work-related injury outcome that prevents a return to the
person’s previous (pre-incident) whole person function within 180 days as a result of an acute,
single incident resulting in any of the following:
• Permanent loss of body parts
• Permanent reduction of organ’s physiological function
• Permanent reduction in skin and musculoskeletal function
• Permanent reduction in psychological, social, or cognitive function
Note: “Whole person function” relates to a person’s biological/physical status as well as their
emotional and social functioning.
Why do the permanent impairment definitions refer to 180 days? This is a flexibility provided to
allow injured persons a normal healing time to recover back to full function. All injuries have
expected healing times. The healing time needed will depend on the severity of the injury, (degree
of the tissue damage) the characteristics of the tissue(s), injured as well as personal health factors.
Defining PFPI(Potential Fatality/ Permanent Injury)
Potential FPI (PFPI):
Accident PFPI: An event that resulted in an injury (first aid and recordable) that could have realistically resulted in a fatality or permanent impairment
(class “A” event).
Near Miss PFPI: An event that could have realistically resulted in a fatality or permanent impairment where there was no actual injury.
Observation PFPI: An observation that could have realistically resulted in a fatality or permanent impairment
How do you define Potential ?
In 2019, the Edison Electric Institute (EEI) working group created the Safety Classification and
Learning (SCL) Model, advised and coordinated by Dr. Matt Hallowell. In an effort to enhance
shared learning and create more meaningful safety metrics, the model was created to help
organizations consistently and reliably classify and define incidents and observations. The
elegance of the SCL model is that any classification is based upon the answer to the following
four yes/no questions:
1. Was there high energy?
2. Was there an accident?
3. Was there direct barrier?
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1. Was there High Energy? Common High Energy Hazards
Motor Vehicles Estimations of the motor vehicle
speed typically involved in serious or fatal crashes
Suspended Load: Most suspended loads require vary greatly, EEI selected a conservative estimate of
specialty equipment to lift more than 225 kg of load 45 KMPH as the high-energy threshold. This energy
higher than 1 ft off the ground. In such a case, the exposure is taken from the point of view of the
suspended load would exceed the high-energy vehicle occupants, including the driver.
threshold.
Rotating Equipment: Computing mechanical energy
can be complex as it requires estimation of moment
of inertia and angular velocity for rotating objects
and stiffness & displacement for tension or
Fall from Elevation: Considering the average weight of a compression. Thus, all heavy rotating equipment
human is more than 68kg, 4 ft (1.2 m) of elevation beyond powered hand tools typically exceed high-
(measured from the ground surface to the bottom of energy threshold & should be regarded high energy
the feet) exceeds the high energy threshold.
Electrical contact with Source: Electricity > 50 V is
sufficient to result in serious injury or death
according to NFPA 70E.
Mobile Equipment / Traffic with workers on foot:
Because of the mass, most mobile equipment including
motor vehicles exceeds the high-energy threshold when Arc Flash: Any arc flash exceeds the high-energy
the equipment or vehicle is in motion at any speed. The
energy exposure is taken from the point of view of the threshold because of the voltage exposure according
worker on foot and not the equipment operator or to NFPA 70E (2024)
vehicle driver. (Note: For work zone traffic, an incident
occurs only when a vehicle departs from the intended
path of travel and is within 1.8 meter of an exposed
employee, or if an employee enters the traffic pattern.)
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1. Was there High Energy? Common High Energy Hazards
Excavation or trench: An exposure to unsupported Fire with sustained fuel source: According to
soil in a trench or excavation more than 5 ft (1.5M) deep the North American Combustion Handbook (Reed,
exceeds the high-energy threshold. Typically, for each 1978), a lightly combustible material such as paper
foot of depth, soil pressure increases by about 40 lb per burns at approximately 700 °F (370°C) , far
square foot. Thus, at a depth of 5ft, the pressure is exceeding the temperature threshold
approximately 200 lb per square foot.
Toxic chemical or radiation: The following
references should be used
Explosion: Most incidents described as an explosion to judge acceptable exposure limits:
exceed the high-energy threshold. • Immediately dangerous to life or health (IDLH)
values from NIOSH
• Exposures which reduce oxygen levels below 16%
• Corrosive chemical exposures (pH < 2 or > 12.5)
High temperature: According to the American Burn
Association (2023), exposure to any substance >150 °F
(65°C) typically causes third-degree burns when There are situations when objects like tools,
contacted for 2 secs or more. materials, or equipment have enough energy to
exceed the 500-ft-lbs threshold but are not included
as an icon. For these circumstances, energy
assessment graphs can be used - potential energy
(gravity). To use the graph for gravity, one simply
must estimate the weight of the object in pounds
Steam: According to the American Burn Association and the height of the object in feet. If the point
(2023), any circumstances with the release of steam where the lines intersect is in the red zone, the
exceeds the high energy condition exceeds 500 ft-lbs and is most likely to
result in FPI
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2. Was there an Accident/Near Miss
An instance where the high-energy source was released and where the worker came in contact with or proximity to the high-energy
source.
To ensure consistent application of this definition, the team defined “energy release” as an instance where, the energy source
changes state while exposed to the work environment. Examples of energy release could be a tool that is dropped and transitions
from potential to kinetic energy, or a person who loses control of their balance and stumbles. The energy release is always related
to an instance where the energy is no longer contained or in the control of the worker. Finally, the worker must either have contact
with the energy or be in proximity to the energy.
“Contact” is defined as an instance when the high energy is transmitted to the human body.
“Proximity” is defined as a hazardous circumstance where the boundary of the high-energy exposure is
1) within 2 meters of the worker;
2) within a confined space; or
3) within a situation where, a worker cannot escape the energy source (restricted egress).
High-energy
High Energy Present Energy Released Contact or proximity
Incident
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3. Was there a barrier present?
PFPI
Was high energy Obs
For each high energy source, a direct barrier involved? without
is present if: Barrier
Yes No
1. The barrier is specifically targeted to
No
the high-energy source Was there a high-energy Was a direct barrier
2. The control effectively mitigates incident? present?
exposure to the high energy source
when installed, verified, and used Yes
Yes
properly (i.e., a FPI incident cannot Success
reasonably occur)* No
Positive
Obs
3. The control is effective even if there is Was a Serious Injury
Sustained?
unintentional human error during the
work period (unrelated to the
installation of the control) Was a direct barrier
Yes present?
No Yes
***Success: Condition where a high-energy PFPI PFPI
accident / Accident/
hazard was present and had a corresponding FPI
NM NM with
direct control without barrier
Barrier
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Case Study
Case 01
An employee was performing manual handling near a scaffold
under erection.
A loud sound was heard, and he noticed that a scaffold pipe
weighing 6 KG has fallen from under construction scaffold platform
at a height of 20 meters into the barricaded drop zone close to
him.
The employee reported this as near miss
Case Study -1
Interpretation :
- Was high-energy present? Yes, the scaffold pipe weighs 6kg and has dropped from a height of 20 meters
- Was there a high-energy Incident ? Yes, a Near miss as no injury was sustained
- Was a direct barrier present? Yes, a barricaded drop zone was present under the Piperack.
Conclusion: PFPI NM with barrier
Case Study -2
Case 02
An employee was driving a car in the PV project at a speed of over
50KMPH
At a “T” intersection he failed to slowdown and hit a vertical post
resulting in 1 MTC injury to a passenger in rear who was not
wearing seatbelt.
Accident is reported as MVA with loss potential as MTC
Case Study - 2
Interpretation:
- Was high-energy present? Yes, the driver was driving the vehicle over 50KMPH
- Was there a high-energy accident? Yes, the vehicle hit the vertical post and a MVA occurred
- Was a direct barrier present? No, passengers were not wearing seat belts
Conclusion: PFPI accident without barrier
Case Study - 3
Case 03
Workers were hoisting load (85kg) onto a scaffold at 16 m height. A
certified operator operated an air hoist to lift the load.
As the lift was performed, the rigging was caught into a scaffold.
Under the increasing tension, the rigging compromised, and load fell
on to a worker standing near by, fully fracturing his femur.
An investigation indicated that the rigging safety was not properly
assessed before the lift.
Case Study - 3
Interpretation:
- Was a high-energy present? Yes, hoisting the load with the weight meet the suspended load criterion and
far exceed the 500 ft-lbs threshold for gravity (see gravity energy chart)
- Was there a high-energy accident? Yes, a fractured femur requires around 6 months for recovery
- Was a direct barrier present? No, the rigging was not properly planned
Conclusion: FPI
Case Study - 4
Case 04
A worker was performing maintenance job on a DTH machine at around
10 meters without any fall prevention controls in place
HSE Officer approached and asked the workers to come down
Worker did a Tarzan Move and came down
Reported this incident as a HSE Observation – Unsafe act
Case Study - 4
Interpretation:
- Was a high-energy present? Yes, the employee was working at a height of over 10M without fall protection
- Was there a high-energy accident? No, the observer intervened**(Could have handled better) before the energy was
released
- Was a direct barrier present? No
Conclusion: PFPI observation
Look for PFPI in Routine
Water? What Water? PFPI? What PFPI?
Like a fish doesn’t know it's in water, a construction worker doesn't always see the danger he's
surrounded by—because it's all he's ever known."
Let's Play a Game (Jenga)
Look for Precursors in Routine
What is a precursor? Precursors are reasonably detectable
events, conditions, or actions that can serve as warning signs of a
FPI event. Typically, they are unusual circumstances (i.e.,
anomalies). They are not the same as root causes. Although root
causes are important to manage, they are not considered
precursors unless they can be assessed through a brief field
engagement
Why Precursors? The rearview mirror is important, but we need
to be looking through the windshield
Precursors
Precursor Description
Workers cannot express the core elements of the safe/standard
Safe Work Procedure
workplan for their task.
Workers do not recognize hazards or properly evaluate the severity of
Hazard Recognition
risks.
Unfamiliar or unforeseen task or job site conditions that depart from a
Departure from Routine
well-established routine
Workers do not stop and reassess conditions when work
Plan to Address Work Change
changes from what is planned (i.e., switch to plan B).
Workers demonstrate priority of productivity, heroic tendencies,
Safety Attitudes
invulnerability, fatalism, or summit fever
Adequate rules and procedures are documented and communicated
Rules and Procedures but not followed by workers. The correct procedure is documented
and communicated to workers, but they are not followed
Precursors
Precursor Description
Workers are not familiar with task expectations or performance
Familiarity with Task standards because of a lack of experience or significant procedural
change.
Lower perception of risk or higher risk tolerance resulting from
Risk Normalization
repeated exposures. Tied to procedural drift.
Workers feel an unusual amount of pressure to work quickly and
Productivity Pressure
complete their task.
Lessons learned from previous projects and events are not
Perceived Safety Culture
incorporated into planning and execution.
Workers do not have the ability, or management does not encourage,
Stop-Work Execution
stopping work to address hazards.
Workers are not engaged with or diligently participating in
Workers Inactive in Safety
safety activities
Pre-Task Plan Workers have not completed an adequate pre-task safety plan
Precursor Analysis
What is precursor analysis? Precursor analysis is the process of
observing an environment and engaging with field personnel prior to
beginning work to determine if warning signs of FPI events may be
present.
Through a brief discussion with workers and targeted observations of
the work environment, an observer can assess the worker’s readiness
to begin work.
In simple terms, precursor analysis helps an observer to determine
whether identified ingredients of a potential FPI event may be present
before work starts
3 FPI Prevention Questions for High-Risk jobs
1. Whats could kill you or seriously injure you during this work?
2. What are the controls stop that from happening?
3. Is it enough?
FPI Prevention Strategy
PFPI can be a difficult topic to discuss at work. As a result, teams may have limited knowledge
Action:
Educate
Train employees to recognize and report FPI precursors and PFPI observations. It’s important that employees can identify events
with FPI potential
Start using PFPI reporting module in Syneri Life
Instead of focusing solely on lagging indicators (i.e. incident/FPI metrics, post-incident investigations), widen your data pool by using
leading indicators like risk assessments, observational insights
Action:
Analyze List down the activities at site with FPI potential based on high energy criteria
Ensure critical controls are identified for these activities – Develop One where needed
Analyze PFPI observations and discuss these PFPI observations/Near Misses in your weekly team meetings to reinforce the critical
controls
Take a proactive approach to safe operations. Encourage a mindset of ‘starting when safe’ in addition to the well-established practice
of “stopping when unsafe”
Reframe Action:
OWN & Drive implementation of Critical control checklists - critical controls must be present in a FPI potential situation
Focus on STCKY(Stuff that can Kill You)
& Critical Controls
Critical Controls Checklists
1. Lifting Operations
2. Working at Height
3. Excavations
4. Confined spaces
5. Electrical works
6. Pressurized systems
7. Hot Works
8. Hazardous Materials
9. Man-Machine interface
10. Working over or near water
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