Facilities Division Safety Mishap Reporting

incident reporting

EMERGENCIES:  DIAL 911  EHS Emergency Page

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!  

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

Injuries resulting in the need for an employee to be seen by a medical provider requires notification (24 hours) of the incident to the respective unit director (following the established ‘chain-of-command’).  The unit director will notify the facilities division Associate Vice Chancellor.  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.

Click on the image below to access the Facilities Division Injury Reporting Process Flow:

The image is a flow chart that helps supervisors decide which forms are required to be completed when an injury occurs and who needs to be notified. This is also provided in the written standard operating procedure.
Facilities Division Injury Reporting Process Flow

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