Injury, Illness, Incident and Accident Program Template
Injury, Illness, Incident and Accident Program
Table of Contents
I. OBJECTIVE AND SCOPE
II. DEFINITIONS
III. RESPONSIBILITIES
A. Employee
B. Supervisor
C. Management
D. Third Party Contractors
IV. PROCEDURE
A. Reporting Injuries, Illnesses, Incidents and Accidents
B. First Aid and Medical Services
C. Investigation of Injuries, Illnesses, Incidents and Accidents
D. Recordkeeping
VI. REFERENCES
A. Regulatory References
B. NCH Program References
C. Business Unit Program References
D. Site Program References
VII. APPENDICES
Appendix A - Employee Injury, Illness, Accident, Incident and Return to Work Form
VIII. DOCUMENT CONTROL
Injury, Illness, Incident and Accident Program
for
[Company Name/Location]
I. OBJECTIVE AND SCOPE
In an effort to maintain a safe and secure work place, [Company Name/Location] has implemented a program for the reporting and investigation of all work related employee injuries and illnesses as well as incidents and accidents that may or may not involve employee injury or property damage. The program provides:
1. a defined reporting and investigation process,
2. direction on actions to be taken by employees, Supervisors and [Company Name/Location] Management for each type of event,
3. directions on securing medical attention, and
4. a defined process for an employee returning to work after medical treatment beyond first aid.
Reporting methods and document requirements are defined within this program. The investigation procedure focuses on determining WHAT happened, HOW it happened, WHY it happened and WHAT preventive actions are necessary to prevent similar incidents. The same procedure should be followed for all events even if no injury, illness or property damage resulted from the event. The methods provided are flexible and allow considerable latitude in the make-up of an accident investigation team and their activities.
The procedures described in this Program are intended to facilitate compliance with applicable governmental regulations. If there is a conflict between this Plan and a governmental regulation, the governmental regulation will apply and this Plan will be modified. However, all other requirements in this Plan apply even if more stringent than governmental regulations.
II. DEFINITIONS
An accident or incident. Is an unplanned, undesired event that may, but does not have to, result in personal injury, property damage, or loss of time, raw material or finished products. Examples include occupational illnesses, uncontrolled fire and explosions, disabling injuries, serious equipment plant or property damage, dangerous occurrences which could have, but did not injure any person, exposures to hazardous substances or circumstances, minor injuries, any other event that could put employees or plant at risk.
First Aid. Is treatment or care given to a patient which requires little to no professional medical skills, regardless of the provider’s credentials. This list provides the full extent of activities that are classified as first aid.
A. Using a non-prescription medication at nonprescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes);
B. Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment);
C. Cleaning, flushing or soaking wounds on the surface of the skin;
D. Using wound coverings such as bandages, Band-Aids™, gauze pads, etc.; or using butterfly bandages or Steri-Strips™ (other wound closing devices such as sutures, staples, etc., are considered medical treatment);
E. Using hot or cold therapy;
F. Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc. (devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes);
G. Using temporary immobilization devices while transporting an accident victim (e.g., splints, slings, neck collars, back boards, etc.).
H. Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister;
I. Using eye patches;
J. Removing foreign bodies from the eye using only irrigation or a cotton swab;
K. Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means;
L. Using finger guards;
M. Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes); or
N. Drinking fluids for relief of heat stress.
Medical Treatment. Means the management and care of a patient to combat disease or disorder. Medical treatment does not include:
A. Visits to a physician or other licensed health care professional solely for observation or counseling;
B. The conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g., eye drops to dilate pupils); or
C. "First aid" as defined in this section.
III. RESPONSIBILITIES
A. Management Responsibilities:
1. Designate a standing committee to review the investigation reports of all injuries, illnesses, incidents and accidents and establish a procedure for reviewing and implementing recommended corrective and preventive actions.
2. Insure that all appropriate internal and external reporting requirements are met for each reported event covered by this program.
3. Communicate to all employees the importance of reporting and investigating injuries, illnesses, incidents and accidents.
4. Communicate to all employees the corrective and preventive actions taken as a result of investigating injuries, illnesses, incidents and accidents.
5. Communicate with the designated contacts or immediate family of any employee seriously injured in the course of work.
B. Supervisor Responsibilities:
1. Arrange for appropriate medical care (see “Medical Treatment” section below) if needed or desired by employee.
2. Complete “Supervisor” sections of the Injury / Illness / Incident / Accident Report found in Appendix A. Sign and date the report, make a copy of this report for your records and send the original to [Responsible Person] or [Region /Corporate Human Resources] (address is listed below). If medical treatment is needed at a later date as a result of this accident, refer Associate to [Region / Corporate Human Resources].
3. Report all injuries, illnesses, incidents and accidents to [Responsible Person] and submit appropriate documentation.
4. Participate in the investigation of all injuries, illnesses, incidents and accidents as required.
5. Insure that each employee treated beyond first aid for a work related injury or illness provides a completed and signed Return to Work form found in Appendix A before allowing the employee to return to work in accordance with any work restrictions.
C. Employee Responsibilities:
1. Promptly seek medical treatment if necessary (see “Medical Treatment” section below).
2. Immediately notify supervisor/designated charge person of work-related accident or illness.
3. Fully complete the appropriate portions of the Injury / Illness / Incident / Accident Report found in Appendix A, sign and date the report.
4. When medical treatment beyond First Aid is required, the Return to Work form found in Appendix A must be completed and signed by the treating Medical Service Provider and returned to the Supervisor or HR before the Associate can return to work. A definition of First Aid is included in Appendix A. This requirement is necessary to insure that [Company Name/Location] is adequately informed of the employee’s fitness for duty and medical restrictions if any.
5. Give all completed forms to your Supervisor for signature and action.
D. Third Party Contractors Responsibilities:
1. Third Party Contractors are required to immediately report to their designated [Company Name/Location] contact all injuries, illnesses, incidents and accidents involving their employees on [Company Name/Location] premises. Third party contractors may submit their own forms as long as they contain at least the same information required by the forms in Appendix A.
2. Third party contractors are required to participate in all injury, illness, incident and accident investigations as required by [Company Name/Location] even if their employees were not involved in the event.
IV. PROCEDURE
A. Guidelines for Reporting Injuries, Illness, Incidents and Accidents
All injuries, illnesses, incidents and accidents are to be reported to the immediate supervisor as soon as possible. Employees who fail to report or document an incident are subject to disciplinary action up to and including discharge.
Accurate information should be recorded on the appropriate forms, provided in Appendix A or included in the references. Rapid reporting is important because delays of even a few hours can result in information or items of importance to be lost, removed, destroyed, or forgotten.
All injuries, illnesses, incidents and accidents will be investigated to determine the underlying cause and as the first step in developing appropriate corrective and preventive action. The investigation is not designed to establish blame but rather, identify the underlying causes of the events so effective corrective and preventive action can be established.
In no event should non-company personnel be allowed at the scene of the incident without express consent of local [Company Name/Location] management. Exceptions are authorized employees of regulatory or law enforcement agencies and medical first responders.
1. General Procedure for reporting an accident, injury, illness or incident
a. The following procedures shall be followed when completing the [Company Name/Location] report forms found in Appendix A. There are several forms in this document and they are to be used as appropriate to the injuries, illnesses, incidents and accidents being reported.
b. All questions, sections, or blanks must be completed. If the blank does not require information, insert N/A.
c. All reports should contain as much detail about the injuries, illnesses, incidents and accidents as possible.
d. Report only the facts that can be ascertained and avoid including opinions.
e. Include diagrams or pictures to help explain the event.
f. It is the supervisor’s responsibility to complete and submit the initial [Company Name/Location] Injury, Illness, Incident and Accident Report and any other reports when appropriate.
2. Procedure for Reporting a Work Related Injury or Illness
The Injury, Illness, Incident, Accident Report form found in Appendix A must be completed and submitted as soon as possible for every work-related event covered by this program. The injured Associate (if possible) and the immediate supervisor are responsible for gathering all of the requested information and reporting it to [Responsible Person] or [Regional / Corporate Human Resources] by telephone, fax, email or overnight mail.
When medical treatment beyond First Aid is required, the Return to Work form found in Appendix A must be completed and signed by the treating Medical Service Provider and returned to the Supervisor or HR before the Associate can return to work. A definition of First Aid is included in Appendix A. This requirement is necessary to insure that [Company Name/Location] is adequately informed of the employee’s fitness for duty and medical restrictions if any.
Below are guidelines for completing the forms found in Appendix A for a Work Related Injury or Illness.
a. Employee Reporting
If an employee is injured at work, develops an illness that may be associated with job activities or otherwise requires First Aid or Medical services as a direct result of work activities or environments, then he or she is required to:
i. Promptly seek medical treatment if necessary (see “Medical Treatment” section below).
ii. Immediately notify the Supervisor or designated in-charge person of the work-related injury or illness.
iii. Complete as many sections as possible of the Injury, Illness, Incident and Accident Report Form in Appendix A, then sign and date the report.
iv. Give form to Supervisor or designated in-charge person for signature and action.
b. Supervisor Action and Reporting Work Related Injury or Illness
When an employee or contract laborer sustains a work related injury or illness the following actions are to be taken:
i. Action Taken By The Supervisor:
a) Aids injured employee(s) and coordinates efforts to obtain proper medical assistance.
b) Secures or assists in securing the scene of the accident to prevent further injury to personnel.
c) Notifies [Company Name/Location] management.
d) Gathers the following information for the first report of injury:
(i) Name of injured party(s).
(ii) Date, time and specific location of accident.
(iii) How the accident occurred.
(iv) Description of injury.
(v) Names of any witnesses and their employer.
(vi) Names of all personnel on location if event occurred at an off-site work location.
(vii) If applicable, estimated time of arrival, name and location of medical treatment facility to which injured party(s) will be transported.
(viii) If possible, and in concert with injured employee, prepares a written statement detailing the conditions and events surrounding the accident.
e) Completes as many sections as possible of the Injury, Illness, Incident or Accident Report Form in Appendix A, signs and dates the report.
f) If the employee does not need or desire medical treatment, make a copy of this report for your records and send the original to [Responsible Person] or [Region / Corporate Human Resources] (address is listed on the Report Form in Appendix A). If medical treatment is needed at a later date as a result of this accident, refer employee to [Responsible Person] or [Region / Corporate Human Resources].
g) Submit all documentation to [Responsible Person] or [Region / Corporate Human Resources] as soon as possible by telephone, fax, email or overnight mail.
h) Submit the Return to Work Form by telephone, fax, email or overnight mail to [Responsible Person] or [Region / Corporate Human Resources].
c. Actions Taken By [Company Name/Location] Management:
i. Dispatch safety coordinator or management personnel to meet and/or accompany injured party to a medical facility if medical care beyond first aid is required. The designee should stay with the injured employee and report condition of injured employee back to management.
ii. Prepare any required First Report of Injury or similar document and submit it to the appropriate State and/or Federal Agencies.
iii. Insure all applicable forms are filled out and distributed to appropriate authorities. Follow up with employee and medical personnel until the employee is released for full duty. Note: A Supplemental Report of Injury may be required by regulatory authorities to report changes in employee work status.