Supervisor’sAccident InvestigationGuide

OVERVIEW:

Immediate action for all injuries:

  • If a serious injury of illness occurs, immediately call Campus Police by dialing 911.
  • Give Campus Police your name, the nature and severity of the medical problem, and the location of the victim. Campus Police will provide immediate medical attention and will arrange transportation if necessary. The injury or illness must be documented with a Supervisor’s Injury or Illness Report.
  • If the injury is minor, an employee with First Aid training may provide First Aid. Administration of First Aid must be documented with a Supervisor’s Injury or Illness Report.
  • Campus Police can be helpful with administering first aid, as well as determining if further medical attention is needed. Campus Police can be reached at campus extension 8444 or by dialing 911.

TheEmployee isrequired toreporttheinjuryto his/hersupervisor assoonas possibleafter theincident/accident.

TheSupervisor/Lead isresponsible:

  1. To assure thatanyinjuredemployeeisgiven immediateandpropermedicalcare(asrequired) andthatnooneelsecanbeinjured.
  2. To complete a Supervisor’s Injury or Illness Report for any injury and submit to Human Resources within 24 hours, no matter how small the injury may seem (First Aid).

Environment, Health and Safetystaffisavailable toassist thesupervisorwith theaccident investigation.

The purposeofaccidentinvestigationis todevelopinformationontheactualandcontributingcausesof accidentsinordertopreventrecurrence. NomatterhowconscientiousthesafetyeffortattheUniversity, accidents aresometimesgoing to happen duetohumanorsystemerror. Ourgoal isto findandremove accidentcausesandtomaketheUniversityasaferplacetowork. Accidentinvestigationshelpusmeetthat goal.

The followingisa briefoverview oftheinvestigationandreportform(Supervisor’s Injury or Illness Report) thatisrequiredforevery employee accident.Allrequired blanks on the report should befilledin.

The investigation should begin by answering the questions: who, what, when, where, and how.

Various steps are involved in gathering this information including:

  • Discussing the accident with the injured employee,
  • Interviewing any witnesses to the accident,
  • Inspection of the accident location,
  • Your knowledge of operations and work methods,
  • Review of maintenance and training records.

FILLING OUT THE FORM

  1. SECTION 1 - GENERALINFORMATION:

Thissectionidentifiestheinjuredemployee;work schedule, thedepartment,and employeestatus.

  1. SECTION 2 - INDUSTRIAL INJURY DATES

Thissectionidentifiestheinjuredemployee’s last day of work and if a claim form was given.

  1. SECTION 3 -ACCIDENT DATA:

Thissectiondescribestheaccidentwithspecificsonwhattheinjuredemployeewasdoingandwhichbody parts(righthand,leftlowerleg,backofhead)wereaffected. Thespecifictimeandplace(building,room, area) of theaccidentisimportantin theinvestigation.

Thetypeofinjurycanbe describedbysuch terms as:foreignbodyineye,cut,punctures,bruise,sprain,strain, fracture,burn,dermatitis, etc.

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DESCRIPTION OFACCIDENT:

  1. Whatwastheemployeedoingat thetimeof theincident?
  2. Whatsequenceof events led to theincident
  3. Whatwerethe workingconditionsand toolsbeing used?
  4. Any witnessesor contributorsto theincident?
  5. How did theaccident happen? (Cause)

Some Accidenttypes include:

  1. Struck against
  2. Struck by anobject
  3. Caught in orbetween
  4. Slipped
  5. Tripped
  6. Overexertion
  7. Inhaled
  8. Absorbed
  9. Ingested
  10. Contact withelectriccurrent

CAUSEOFACCIDENT:

  1. Causesincludeunsafeacts orequipmentaswellas poororimpropertraining.
  2. Otherpossiblecausesmay include:
  3. Improperinstruction
  4. Lackofskill
  5. Operationwithout authority
  6. Horseplay
  7. Physicalimpairment
  8. Failureto warnorsecure
  9. Failuretolockout
  10. Unsafeposition orspeed
  11. Improperprotectiveequipment
  12. Poorhousekeeping
  13. Unsafearrangement
  14. Hazardous condition
  15. Unsafeprocessorprocedure
  16. Unsafeliftingorcarrying
  17. Poorventilationorlighting
  18. Improperguarding
  19. Improper maintenance
  20. Impropersafetydevice
  21. Impropertool
  22. Chemical spill
  23. Lackoftime
  24. Work overload
  25. Failuretoinspect
  26. Failuretoenforce
  27. Noinspectionmade
  28. Failuretotrain employee on hazards

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  1. SECTION 4 - TREATMENT DATA:

This section details if medical treatment was provided and who provided it (facility name and location).

  1. SECTION 5 - CORRECTIVEACTION TAKENOR RECOMMENDED:

Thissectiondescribesthecorrectiveactionthatthesupervisorhastakenorwilltaketopreventsimilar accidentfromoccurring. Thismayrequireactionfromotherdepartments suchasFacility Services forrepairsorEHSfor training.

  • Identify how to prevent similar accidents. Corrective actions could be fixing an unsafe condition, additional training, increased supervision, and change in work methods.
  • Is additional training/coaching needed?
  • Do established work procedures need to be changed?
  • Is a work order needed to correct a hazard?
  1. SECTION 6 – RETURN TO WORK STATUS:

Noteif theemployeeisunable to return to work at Full Duty; ismodifiedduty or transitional work availablefortheinjured employee toreturntowork?

  1. SECTION 7 – ADDITIONAL INFORMATION TO PROVIDE:
  1. Additional comments provided by the Injured Party.
  2. Interviews of any witnesses to the accident, attach statements as necessary.
  3. Examination oftheaccidentsiteandpreservation of thescene,if necessary.
  4. Note any attached photosoradiagramif it helps explain thesituation.
  5. Removal/repairof unsafeconditions.
  6. Useadditionalpagesas required.
  1. SECTION 8 – SIGNATURES
  1. Immediate Supervisor/Lead should complete report.
  • Thesupervisormustsignanddatethereport.
  1. Managers signatureanddate.

SUBMIT FORM TO HUMAN RESOURCES WITHIN 24 HOURS OF INCIDENT

*IMMEDIATE POLICE NOTIFICATION PROTOCOL*

Immediately notify the Police by any communication method available, typically telephone.

  • Any incident involving serious injury or illness
  • Hazardous materials incidents
  • Sewage Spills
  • Pollutants entering storm drains
  • Fire
  • Any incident involving a large State property loss

NOTE: IfyouhaveanyquestionsregardingthecompletionoftheSupervisor’s Injury or Illness Report,pleasecallEnvironment,Health and Safety onextension3922 or 8847.

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