Facilities Division Safety Mishap Reporting

EMERGENCIES:  DIAL 911  EHS Emergency Page
URGENT FACILITY REPAIR: DIAL 515-2991

Reporting is critical to uncovering opportunities to improve our safety management system.  The ultimate goal is to prevent incident recurrence.

Employees are required to report all incidents to their supervisor – immediately – even if no injury occurred.  The supervisor is responsible for completing associated forms and sending them to Environmental Health and Safety (EHS), Workers Compensation, Facilities Human Resources (FHR) and the facilities division safety professional.

To be clear – individual confidentiality is maintained and there is no blame associated with reporting incidents!  

INCIDENT REPORTING FORMS:
Supervisor’s First Report of Incident Form – required for all incidents
Worker’s Compensation Employee Statement Form – required for all incidents with the exception of near misses and property damage
Worker’s Compensation Use of Leave Form – required for all incidents with the exception of near misses and property damage
Supervisor’s Medical Treatment Authorization Form – required when employee sees medical provider

State Property Incident Report – required when there is damage to state property

Motor Vehicle Incident Reporting Kit – required when there is damage to a vehicle

Injuries resulting in the need for an employee to be seen by a medical provider requires notification of the incident to the respective AVC (following the established ‘chain-of-command’).  The AVC will notify the facilities division Associate Vice Chancellor within 24 hours.  The intent of this initiative is to make sure that when incidents occur we are working collaboratively, at all levels of the division, to prevent recurrence.

Incident Reporting forms may be sent to the email group: group-facilities-mishap-report@ncsu.edu . This will route the paper work to Facilities Safety, EHS, and Workers Comp.

Return to Facilities Division Safety Page