Accident Report Procedure
Responsible Office: Environmental Health and Safety
Policy Type: Security and Safety
Policy Number: 806
Last Date Revised: 6/24/19
The objective of this procedure is to meet our legal obligations by assuring correct, adequate, and prompt reporting of all accidents, and to make sure that all necessary agencies are notified of each injury.
An injured employee or student must report any accident where medical attention and/or first aid is required, or whenever any apparent bodily injury was received by the injured. Student accident reports will be completed by the University Health Service if the student reports to the Health Services.
A. Obligations of Injured / Ill Employee
1.Get medical help if needed. Report your injury/illness to your supervisor.
2. All employees must complete a form CS-13 Employee Report of Accident or Injury, within 3 days after the date of the incident. Retain a copy for your files. Forward the original to your supervisor who will complete their portion. Supervisors are to forward the original to Human Resources, with a copy going to the Environmental Health and Safety Office (EH&S). If assistance is required in completing the form, call the EH&S office at 7-2211.
3. Employees may also call the Accident Reporting System (ARS) at 1-888-800-0029 (toll free) 24 hours a day (any day). Such calls allow for immediate access to Worker’s Compensation Benefits. The ARS operator will provide an incident number which can be used to access a work related prescription drug benefit.
Further details on this process can be found on the HR website under forms.
B. Obligations of Supervisor of Injured Person
Complete a form CS-13, Employee Report of Accident or Injury, within 3 days after the date of the incident. Retain a copy for your files. Forward the original to Human Resources, and a copy to the Environmental Health & Safety Office, Health Services Building. If assistance is required in completing the form, call the EH&S office at 7-2211.
C. Number of Reports Required
Use one report form for each person injured even though the injured person may have multiple injuries.
A separate report must be filed for each injured person whenever an injury involves two or more people.
D. Definition of Terms
Employee as used in this procedure, means a person who is on a State payroll at the time of the injury.
This, therefore, does not include employees of the Research Foundation, auxiliary campus enterprises (Bookstore, Vending, Dining Services) and similar organizations. Accidents causing injuries to such non-State employees will be reported as public injuries. Students working for the college and temporarily on State payroll at the time of the accident will be included as employees.
Report completed by - Please print your name, title, and the date of the report.
Safety Supervisor's signature - This section will be signed by the EH&S Associate Director upon review of the report.