Accident Reports: Difference between revisions

From Appalachian State University Policy Manual
 
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== Introduction ==
== Introduction ==


1.1 All Appalachian State University employees are covered under the State Government Workers' Compensation Program. This includes full-time, part-time and temporary employees.
1.1 Appalachian State University (“University”) is committed to providing a safe work environment free of recognized hazards for all employees, students, and visitors.  To accomplish this goal, it is important that everyone take an active role in promoting safety and identifying hazards that could result in injury.  In the event an incident or injury does occur, it is important to quickly report the incident to ensure that proper care is provided to the injured person, and that steps are taken to identify and mitigate any potential hazards to prevent future injury.  Prompt reporting also is necessary in order to satisfy various legal obligations and protect the interests of the University as a whole. This policy outlines the process for reporting occupational incidents and injuries with an emphasis on injury prevention.


1.2 Written reports are required for all occupational accidents, injuries and illnesses to University employees. These reports serve a two fold purpose: first, to meet the requirements of Key Risk Management Services, Inc. and the NC Industrial Commission, and second, to stimulate investigations promoting reduction in both the number and severity of such occurrences.
== Scope ==
2.1 This policy applies to all University employees.


== Scope ==
2.2. The North Carolina Workers’ Compensation Act (N.C.G.S. Chapter 97) covers all University employees.  Any employee who suffers an occupational injury or contracts an occupational illness within the parameters of the North Carolina Workers’ Compensation Act is entitled to benefits and subject to obligations under the Act.  The North Carolina Industrial Commission administers the Workers’ Compensation Act. 
 
2.3 The North Carolina Occupational Safety and Health Act (N.C.G.S. Chapter 95, Article 16) also covers all University employees.  Administration of this Act is handled by the North Carolina Occupational Safety and Health Administration (OSHNC), which falls under the purview of the North Carolina Department of Labor.  Any occupational injuries and illnesses suffered by University employees must be recorded and reported to the proper entities outlined within this policy.  These records must be made available to OSHNC for examination. 


2.4 Each agency listed above has their own unique regulations and reporting requirements, but share the common goal of ensuring a safe work environment for all employees.  It is important that the University community works to comply with the requirements of both North Carolina’s Workers’ Compensation Act and its Occupational Safety and Health Act to ensure that incidents are prevented from occurring and proper care is provided to those that are injured while at work.


== Definitions  ==
== Definitions  ==
=== Amputations ===
:The traumatic loss of a limb or other external body part, including but not limited to complete or partial severance of any appendage; fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; and amputations of body parts that have been since reattached. 
=== EHS&EM ===
:The University’s Office of Environmental Health, Safety and Emergency Management.
=== Employee ===
:All University employees, including full-time EHRA faculty, EHRA non-faculty, and SHRA employees; as well as part-time employees, temporary employees, and student employees.
=== Incident ===
:Any undesired occurrence resulting in a work-related personal injury, illness, damage to property, or loss of process (production) or materials.
=== In-Patient Hospitalization ===
:Formal admission to the in-patient service of a hospital or clinic for care or treatment.
=== Near Hit ===
:Any incident where no property damage occurred or no personal injury was sustained, but where an incident and/or injury could have easily occurred given a slight shift in time or position.
=== Occupational ===
:Of or relating to an employee’s workplace or work responsibilities.
=== Serious Injury ===
:A severe or traumatic injury including but not limited to amputations, significant head injuries (e.g., resulting in a loss of consciousness), loss of an eye(s), any fall resulting in significant injuries, and the impaling of any foreign object into the body.  A serious injury includes any medical condition, such as a heart attack, that results in emergency medical care, in-patient hospitalization, or death.
=== University ===
:Appalachian State University.
=== Workers’ Compensation Administrator (WCA) ===
:The WCA serves as the liaison between the injured employee, the supervisor, the University and the Third Party Administrator to ensure that University employees who are injured on the job receive the medical attention needed.


== Policy and Procedure Statements  ==
== Policy and Procedure Statements  ==
=== Medical Care for Injured Employees ===
4.1.1 In the event an employee receives a work related injury, the primary concern and first priority is to ensure proper medical treatment is provided. 
4.1.2 If the injury or illness is life-threatening, 9-1-1 should be contacted immediately. 
4.1.3 If the injury is not life-threatening, the injured employee should seek initial treatment at Fast Med Urgent Care (FMUC).  If FMUC is not open, the employee should go to the Watauga Medical Center Emergency Room.  If transportation is needed, the injured employee may contact University Police at 262-2150.
4.1.4 Failure to seek initial care from Fast Med Urgent Care or Watauga Medical Center may preclude workers compensation payment.
4.1.5 With the exception of emergency care or initial treatment, any treatment or surgery by a medical professional shall be coordinated with individuals in the University’s Office of Human Resources responsible for handling Workers’ Compensation matters.
=== Employee Responsibilities ===
4.2.1 There are several responsibilities that employees experiencing an occupational incident, including an injury or illness, must fulfill to ensure that future incidents or injuries are prevented, proper care is received, and eligible benefits are received.  The first priority is ensuring that proper emergency care is provided when appropriate.
4.2.2 Employees are required to report immediately, to their supervisor, any incident that occurs as defined in section 3 of this policy.  If the employee is unable to report the incident due to injury, a co-worker may report the injury in their place and the supervisor will follow up with the injured employee as necessary.  Failure to provide timely notice of the incident may result in further injury or illness and/or potentially disqualify the employee from receiving eligible benefits.
4.2.3 Documentation of all incidents, regardless of severity, is required by the employee.  In addition to supervisor notification, the employee shall complete the Initial Notification of Injury (INI) Form within 24 hours of the incident. Failure to timely and accurately report notification of an incident could result in a delay or denial of Workers’ Compensation benefits.  A link to this form is located under the Forms section of this policy.  In the event the injured employee is unable to complete the form, the employee’s supervisor may complete the INI Form on their behalf.
4.2.4 For workers’ compensation, the University’s workers comp administrator will coordinate the benefits process and communicate with the injured employee regarding any additional information or actions needed.  It is the employee’s responsibility to ensure that all requested information is provided completely, accurately, and in a timely manner.
4.2.5 In cases where an occurrence did not result in injury, property damage, or loss of process (production) or materials, but the employee perceives an injury, property damage, or loss of process (production) or materials could have resulted (near hit), the employee shall complete the Initial Notification of Injury Form within 24 hours of the event.  A link to this form is located under the Forms section of this policy.  Completion of this form is vital to documenting minor injuries that may require future medical care, as well as potentially help prevent an incident, injury, or illness from occurring in the future. 
=== Supervisor Responsibilities ===
4.3.1 The supervisor of an injured employee is responsible for immediately contacting the EHS&EM and Human Resources following a Serious Injury as defined in this policy.  Failure to contact EHS&EM within 6 hours of the occurrence of a Serious Injury could result in a violation of OSHNC regulations and potential fines for the University.  Completion of the forms mentioned in this policy does not substitute the need to contact the EHS&EM office directly.
4.3.2 During business hours (8 am -5 pm, Monday-Friday), the supervisor shall report to EHS&EM and Human Resources either in person or by calling EHS&EM’s main telephone line (828-262-4008) and the Workers’ Comp Administrator at 828-262-6488.  If there is no answer, the supervisor shall follow the after-hours protocol found below (see section 4.3.3).
4.3.3 After hours, including weekends and holidays, the supervisor shall contact University Police at 828-262-2150 to report the incident.  The supervisor must provide a brief description of the incident and their contact information.  A member of the EHS&EM team will be notified by University Police and EHS&EM will follow-up with the supervisor. 
4.3.4 Should an injured employee be required to miss work due to an occupational injury or illness, or to work in a reduced capacity (restricted or light duty), the supervisor shall communicate this information to an individual in the University’s Office of Human Resources responsible for handling Workers’ Compensation matters.  This information must be reported.  For assistance in determining whether the injured employee meets the definition of missed work time or restricted duty, contact the Office of Human Resources (828-262-6488). 
4.3.5 The supervisor of the employee involved in an incident, injury, or near hit shall conduct an investigation, regardless of incident severity.  The supervisor shall complete the Supervisor’s Investigation Form, and  forward copies to the Workers’ Comp Administrator and EHS&EM within 24 hours of the incident.  The Supervisor’s Investigation Form can be found in the Forms section of this policy.
=== University Occupational Accident and Injury Investigations ===
4.4.1 Supervisor Investigations
The injured employee’s supervisor shall take an active role in investigating incidents, to include injuries and near hits.  Supervisors shall conduct a review of any incident to determine the root cause and ways to prevent future injuries. The purpose of these investigations is not to affix blame, but to identify safety hazards and work to prevent future injuries. 
Supervisors may contact EHS&EM for assistance with investigations and/or utilize the supervisor’s investigation guide found at the end of this policy.  Training on how to conduct incident investigations is also available through EHS&EM.
4.4.2 Environmental Health, Safety, and Emergency Management Investigations
Information obtained from the initial report of an incident or near hit will be used to determine if an incident investigation by EHS&EM will be conducted.  Determining factors may include the nature of the injury or illness, the severity of the incident, prior occurrence of related incidents, request for assistance with an investigation, and other factors. 
EHS&EM will conduct an investigation on all workplace incidents, injuries, and fatalities.  EHS&EM will review all supervisor incident investigations to determine if any additional actions are needed based on supervisor findings. 
The purpose of EHS&EM investigations is to determine the root cause of an incident in order to help prevent future injuries from occurring. 


=== Worker's Compensation Benefits ===
EHS&EM will be responsible for notifying and coordinating with OSHNC and NCOSHR upon notification of reportable accidents and injuries. 


4.1.1 An employee who suffers an occupational illness, an accidental injury on the job, or while engaged in University approved travel or off campus business, may be eligible for workers' compensation benefits. The following procedures must be followed in order to be compensated under North Carolina Industrial Commission rules. Claims will be denied unless these procedures are followed.
4.4.3 Worker’s Compensation Investigations
#You must seek non-emergency treatment at the Student Health Services if the injury is not a danger to life or limb. If the Student Health Services is closed (or such a danger exists), initial treatment must be provided at the Watauga Medical Center Emergency Room. If an employee needs transportation to Student Health Services or Watauga Medical Center, please contact the University Police Department at 262-2150.
#Referrals to other treating physicians or surgeons must be approved by the treating physician, Key Risk Management Services, Inc., NC Industrial Commission of Occupational Safety and Health Office.
#An interview may be conducted with the injured employee, if necessary, to assist in determining if the injury is compensable under North Carolina Industrial Commission rules. The employee may be asked to write a brief description of the accident.
#A completed North Carolina Industrial Commission "Form 19" must be forwarded to the Occupational Safety and Health Office within 24 hours of the occurrence. Completed "Supervisor's Accident Report Form", "Employee's Statement and Leave Options Form" and "Medical Records Release Form" must be forwarded to the Occupational Safety and Health Office within five (5) days of the occurrence. Copies of the Workers' Compensation reporting forms may be accessed from ASU's HOme Web Page Site under Electronic Forms, Occupational Safety and Health section.


4.1.2 Contact the Occupational Safety and Health Office at 262-4008 if you have questions.
The Worker’s Compensation Administrator and third party claims administrator may opt to conduct an independent or joint investigation (with EHS&EM) of occupational injuries and illnesses. The purpose of this investigation is to aid in the determination of liability and compensability.


=== Reports by the Occupational Safety and Health Office ===
=== Corrective Actions ===


4.2.1 North Carolina Occupational Safety and Health Standards require the recording and maintenance of the specialized reports of occupational injuries and illnesses as follows:
4.5.1 Hazards discovered during the investigation process of occupational incidents and injuries shall be referred by EHS&EM to the appropriate department head for correction.
#A continuously maintained log of each recordable occupational illness or injury reported to the Occupational Safety and Health Office.
#An annual summary analysis of injuries and illnesses for public posting from February through April each year.


4.2.2 A quarterly report of OSHA recordable illnesses and injuries plus Workers' Compensation reported illnesses and injuries, including medical and other claim-related expenses, is prepared and forwarded to Employee Risk Control Services Division, North Carolina Office of State Personnel.
4.5.2 The department head where the employee reports is responsible for ensuring that identified hazards are corrected.


=== Non-Occupational Accidents ===
4.5.3 If hazards cannot be immediately corrected, the department head shall take appropriate action to ensure to the best of their ability that a similar injury or illness does not occur.  This may necessitate a change in operations or restricting access to a given area. 


4.3.1 The Occupational Safety and Health Office also maintains pertinent data on other non-work related accidents that occur on campus that result in injuries or illnesses to campus students, staff, faculty and visitors. These reports help with efforts to correct defects in campus equipment, improve unsafe areas and reduce the likelihood of similar occurrences. The single page "Accident Report Form" should be completed for non-work related accidents. A copy of the form should be kept in the department and copies forwarded to the Occupational Safety and Health Office and the University Attorney. Copies of this form may be accessed from the Electronics Forms on ASU's Home Web Page. Contact the Office of Occupational Safety and Health at 262-4008 for copies of this report or other questions.
4.5.4 If the supervisor of an injured employee discovers any hazards while conducting an incident investigation, the supervisor will either correct the hazard(s), consult with EHS&EM for guidance on how to proceed, or forward the identified hazards to the appropriate department head for correction.  


4.3.2 Injured University students should seek immediate medical treatment for injuries or illnesses at the Student Health Services. If considered to be life threatening, or if the Student Health Services is closed, emergency treatment should be sought at the Watauga Medical Center Emergency Room.
4.5.5 EHS&EM shall be notified by the appropriate department head when identified hazards have been corrected. If hazards cannot be immediately corrected, a correction plan shall be provided to EHS&EM outlining prevention strategies and an estimated date of correction.  


4.3.3 Staff, faculty and visitors should seek immediate medical treatment for injuries or illnesses determined to be non-work related at the Watauga Medical Center Emergency Room or from their own physician.
4.5.6 EHS&EM may be contacted at any time for consultation and guidance.  However, corrective actions remain the responsibility of the department head.
 
=== University Reports ===


=== Accident Report Form ===
4.6.1 The North Carolina Occupational Safety and Health Act requires the recording and maintenance of the specialized reports of occupational injuries and illnesses as follows:
4.4.1 A copy of the Accident Report Form can be obtained from the [https://forms.appstate.edu/ University's Electronic Forms Web Site].


=== Supervisor's Accident Report Form ===
4.6.1a A continuously maintained log of each recordable occupational illness or injury. This report is referred to as the OSHA 300 Log, and is maintained by the Workers’ Compensation Administrator in Human Resources.  
A copy of the Supervisor's Accident Report Form can be obtained from the [https://forms.appstate.edu/ University's Electronic Forms Web Site].


=== Employer's Report of Injury to Employee ===
4.6.1b An annual summary analysis of injuries and illnesses for public posting from February 1st through April 30th of each year.  This report is referred to as the OSHA Form 300A, and is also maintained by the Workers’ Compensation Administrator in Human Resources. 
 
A copy of I.C. Form 19 can be obtained from the [https://forms.appstate.edu/ University's Electronic Forms Web Site].
=== Forms ===
 
4.8.1 [https://hr.appstate.edu/hr-services/leave-management/workers-compensation/initial-notification-incidentinjury-form Initial Notification of Incident Form]
 
 
4.8.2 [https://hr.appstate.edu/sites/hr.appstate.edu/files/wc_supervisor_documentation_0.pdf Supervisor Accident Investigation Form]


== Additional References ==
== Additional References ==
:[https://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByChapter/Chapter_97.html North Carolina Workers’ Compensation Act, N.C.G.S. Chapter 97]
:[https://www.ncleg.gov/Laws/GeneralStatuteSections/Chapter95 North Carolina Occupational Safety and Health Act, N.C.G.S. Chapter 95, Article 16}]
:[https://www.osha.gov/recordkeeping/ OSHNC Part 1904 – Recordkeeping]
:[https://www.labor.nc.gov/safety-and-health/occupational-safety-and-health North Carolina Department of Labor, Division of Occupational Safety and Health]
:[https://oshr.nc.gov/documents/incident-investigation-and-reporting-program North Carolina Office of State Human Resources, Incident Investigation and Reporting Program]
:[https://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_143/Article_63.html State Employees Workplace Requirements Program for Safety, Health, and Workers’ Compensation.  N.C.G.S. section 143-580, et seq. and 25 NCAC, 01N .0100, et seq.]


== Authority ==
== Authority ==
 
:[https://www.nccu.edu/formsdocs/proxy.cfm?file_id=3561The University of North Carolina Policy Manual, The Code Section 502]


== Contact Information ==
== Contact Information ==
 
:Accident and Injury Investigations and Prevention – Environmental Health, Safety and Emergency Management (828.262.4008)
:Worker’s Compensation – Human Resources (828.262.6488)


== Original Effective Date ==
== Original Effective Date ==


== Revision Dates ==
== Revision Dates ==
 
:July 11, 2019
[[Category:Contents]]
[[Category:Contents]]
[[Category:Public_Safety]]
[[Category:Public_Safety]]
[[Category:Environmental Health and Safety]]
[[Category:Environmental Health and Safety]]

Latest revision as of 17:50, 16 July 2019

Policy 303.5

Introduction

1.1 Appalachian State University (“University”) is committed to providing a safe work environment free of recognized hazards for all employees, students, and visitors. To accomplish this goal, it is important that everyone take an active role in promoting safety and identifying hazards that could result in injury. In the event an incident or injury does occur, it is important to quickly report the incident to ensure that proper care is provided to the injured person, and that steps are taken to identify and mitigate any potential hazards to prevent future injury. Prompt reporting also is necessary in order to satisfy various legal obligations and protect the interests of the University as a whole. This policy outlines the process for reporting occupational incidents and injuries with an emphasis on injury prevention.

Scope

2.1 This policy applies to all University employees.

2.2. The North Carolina Workers’ Compensation Act (N.C.G.S. Chapter 97) covers all University employees. Any employee who suffers an occupational injury or contracts an occupational illness within the parameters of the North Carolina Workers’ Compensation Act is entitled to benefits and subject to obligations under the Act. The North Carolina Industrial Commission administers the Workers’ Compensation Act.

2.3 The North Carolina Occupational Safety and Health Act (N.C.G.S. Chapter 95, Article 16) also covers all University employees. Administration of this Act is handled by the North Carolina Occupational Safety and Health Administration (OSHNC), which falls under the purview of the North Carolina Department of Labor. Any occupational injuries and illnesses suffered by University employees must be recorded and reported to the proper entities outlined within this policy. These records must be made available to OSHNC for examination.

2.4 Each agency listed above has their own unique regulations and reporting requirements, but share the common goal of ensuring a safe work environment for all employees. It is important that the University community works to comply with the requirements of both North Carolina’s Workers’ Compensation Act and its Occupational Safety and Health Act to ensure that incidents are prevented from occurring and proper care is provided to those that are injured while at work.

Definitions

Amputations

The traumatic loss of a limb or other external body part, including but not limited to complete or partial severance of any appendage; fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; and amputations of body parts that have been since reattached.

EHS&EM

The University’s Office of Environmental Health, Safety and Emergency Management.

Employee

All University employees, including full-time EHRA faculty, EHRA non-faculty, and SHRA employees; as well as part-time employees, temporary employees, and student employees.

Incident

Any undesired occurrence resulting in a work-related personal injury, illness, damage to property, or loss of process (production) or materials.

In-Patient Hospitalization

Formal admission to the in-patient service of a hospital or clinic for care or treatment.

Near Hit

Any incident where no property damage occurred or no personal injury was sustained, but where an incident and/or injury could have easily occurred given a slight shift in time or position.

Occupational

Of or relating to an employee’s workplace or work responsibilities.

Serious Injury

A severe or traumatic injury including but not limited to amputations, significant head injuries (e.g., resulting in a loss of consciousness), loss of an eye(s), any fall resulting in significant injuries, and the impaling of any foreign object into the body. A serious injury includes any medical condition, such as a heart attack, that results in emergency medical care, in-patient hospitalization, or death.

University

Appalachian State University.

Workers’ Compensation Administrator (WCA)

The WCA serves as the liaison between the injured employee, the supervisor, the University and the Third Party Administrator to ensure that University employees who are injured on the job receive the medical attention needed.

Policy and Procedure Statements

Medical Care for Injured Employees

4.1.1 In the event an employee receives a work related injury, the primary concern and first priority is to ensure proper medical treatment is provided.

4.1.2 If the injury or illness is life-threatening, 9-1-1 should be contacted immediately.

4.1.3 If the injury is not life-threatening, the injured employee should seek initial treatment at Fast Med Urgent Care (FMUC). If FMUC is not open, the employee should go to the Watauga Medical Center Emergency Room. If transportation is needed, the injured employee may contact University Police at 262-2150.

4.1.4 Failure to seek initial care from Fast Med Urgent Care or Watauga Medical Center may preclude workers compensation payment.

4.1.5 With the exception of emergency care or initial treatment, any treatment or surgery by a medical professional shall be coordinated with individuals in the University’s Office of Human Resources responsible for handling Workers’ Compensation matters.

Employee Responsibilities

4.2.1 There are several responsibilities that employees experiencing an occupational incident, including an injury or illness, must fulfill to ensure that future incidents or injuries are prevented, proper care is received, and eligible benefits are received. The first priority is ensuring that proper emergency care is provided when appropriate.

4.2.2 Employees are required to report immediately, to their supervisor, any incident that occurs as defined in section 3 of this policy. If the employee is unable to report the incident due to injury, a co-worker may report the injury in their place and the supervisor will follow up with the injured employee as necessary. Failure to provide timely notice of the incident may result in further injury or illness and/or potentially disqualify the employee from receiving eligible benefits.

4.2.3 Documentation of all incidents, regardless of severity, is required by the employee. In addition to supervisor notification, the employee shall complete the Initial Notification of Injury (INI) Form within 24 hours of the incident. Failure to timely and accurately report notification of an incident could result in a delay or denial of Workers’ Compensation benefits. A link to this form is located under the Forms section of this policy. In the event the injured employee is unable to complete the form, the employee’s supervisor may complete the INI Form on their behalf.

4.2.4 For workers’ compensation, the University’s workers comp administrator will coordinate the benefits process and communicate with the injured employee regarding any additional information or actions needed. It is the employee’s responsibility to ensure that all requested information is provided completely, accurately, and in a timely manner.

4.2.5 In cases where an occurrence did not result in injury, property damage, or loss of process (production) or materials, but the employee perceives an injury, property damage, or loss of process (production) or materials could have resulted (near hit), the employee shall complete the Initial Notification of Injury Form within 24 hours of the event. A link to this form is located under the Forms section of this policy. Completion of this form is vital to documenting minor injuries that may require future medical care, as well as potentially help prevent an incident, injury, or illness from occurring in the future.

Supervisor Responsibilities

4.3.1 The supervisor of an injured employee is responsible for immediately contacting the EHS&EM and Human Resources following a Serious Injury as defined in this policy. Failure to contact EHS&EM within 6 hours of the occurrence of a Serious Injury could result in a violation of OSHNC regulations and potential fines for the University. Completion of the forms mentioned in this policy does not substitute the need to contact the EHS&EM office directly.

4.3.2 During business hours (8 am -5 pm, Monday-Friday), the supervisor shall report to EHS&EM and Human Resources either in person or by calling EHS&EM’s main telephone line (828-262-4008) and the Workers’ Comp Administrator at 828-262-6488. If there is no answer, the supervisor shall follow the after-hours protocol found below (see section 4.3.3).

4.3.3 After hours, including weekends and holidays, the supervisor shall contact University Police at 828-262-2150 to report the incident. The supervisor must provide a brief description of the incident and their contact information. A member of the EHS&EM team will be notified by University Police and EHS&EM will follow-up with the supervisor.

4.3.4 Should an injured employee be required to miss work due to an occupational injury or illness, or to work in a reduced capacity (restricted or light duty), the supervisor shall communicate this information to an individual in the University’s Office of Human Resources responsible for handling Workers’ Compensation matters. This information must be reported. For assistance in determining whether the injured employee meets the definition of missed work time or restricted duty, contact the Office of Human Resources (828-262-6488).

4.3.5 The supervisor of the employee involved in an incident, injury, or near hit shall conduct an investigation, regardless of incident severity. The supervisor shall complete the Supervisor’s Investigation Form, and forward copies to the Workers’ Comp Administrator and EHS&EM within 24 hours of the incident. The Supervisor’s Investigation Form can be found in the Forms section of this policy.

University Occupational Accident and Injury Investigations

4.4.1 Supervisor Investigations

The injured employee’s supervisor shall take an active role in investigating incidents, to include injuries and near hits. Supervisors shall conduct a review of any incident to determine the root cause and ways to prevent future injuries. The purpose of these investigations is not to affix blame, but to identify safety hazards and work to prevent future injuries.

Supervisors may contact EHS&EM for assistance with investigations and/or utilize the supervisor’s investigation guide found at the end of this policy. Training on how to conduct incident investigations is also available through EHS&EM.

4.4.2 Environmental Health, Safety, and Emergency Management Investigations

Information obtained from the initial report of an incident or near hit will be used to determine if an incident investigation by EHS&EM will be conducted. Determining factors may include the nature of the injury or illness, the severity of the incident, prior occurrence of related incidents, request for assistance with an investigation, and other factors.

EHS&EM will conduct an investigation on all workplace incidents, injuries, and fatalities. EHS&EM will review all supervisor incident investigations to determine if any additional actions are needed based on supervisor findings.

The purpose of EHS&EM investigations is to determine the root cause of an incident in order to help prevent future injuries from occurring.

EHS&EM will be responsible for notifying and coordinating with OSHNC and NCOSHR upon notification of reportable accidents and injuries.

4.4.3 Worker’s Compensation Investigations

The Worker’s Compensation Administrator and third party claims administrator may opt to conduct an independent or joint investigation (with EHS&EM) of occupational injuries and illnesses. The purpose of this investigation is to aid in the determination of liability and compensability.

Corrective Actions

4.5.1 Hazards discovered during the investigation process of occupational incidents and injuries shall be referred by EHS&EM to the appropriate department head for correction.

4.5.2 The department head where the employee reports is responsible for ensuring that identified hazards are corrected.

4.5.3 If hazards cannot be immediately corrected, the department head shall take appropriate action to ensure to the best of their ability that a similar injury or illness does not occur. This may necessitate a change in operations or restricting access to a given area.

4.5.4 If the supervisor of an injured employee discovers any hazards while conducting an incident investigation, the supervisor will either correct the hazard(s), consult with EHS&EM for guidance on how to proceed, or forward the identified hazards to the appropriate department head for correction.

4.5.5 EHS&EM shall be notified by the appropriate department head when identified hazards have been corrected. If hazards cannot be immediately corrected, a correction plan shall be provided to EHS&EM outlining prevention strategies and an estimated date of correction.

4.5.6 EHS&EM may be contacted at any time for consultation and guidance. However, corrective actions remain the responsibility of the department head.

University Reports

4.6.1 The North Carolina Occupational Safety and Health Act requires the recording and maintenance of the specialized reports of occupational injuries and illnesses as follows:

4.6.1a A continuously maintained log of each recordable occupational illness or injury. This report is referred to as the OSHA 300 Log, and is maintained by the Workers’ Compensation Administrator in Human Resources.

4.6.1b An annual summary analysis of injuries and illnesses for public posting from February 1st through April 30th of each year. This report is referred to as the OSHA Form 300A, and is also maintained by the Workers’ Compensation Administrator in Human Resources.

Forms

4.8.1 Initial Notification of Incident Form


4.8.2 Supervisor Accident Investigation Form

Additional References

North Carolina Workers’ Compensation Act, N.C.G.S. Chapter 97
North Carolina Occupational Safety and Health Act, N.C.G.S. Chapter 95, Article 16}
OSHNC Part 1904 – Recordkeeping
North Carolina Department of Labor, Division of Occupational Safety and Health
North Carolina Office of State Human Resources, Incident Investigation and Reporting Program
State Employees Workplace Requirements Program for Safety, Health, and Workers’ Compensation. N.C.G.S. section 143-580, et seq. and 25 NCAC, 01N .0100, et seq.

Authority

University of North Carolina Policy Manual, The Code Section 502

Contact Information

Accident and Injury Investigations and Prevention – Environmental Health, Safety and Emergency Management (828.262.4008)
Worker’s Compensation – Human Resources (828.262.6488)

Original Effective Date

Revision Dates

July 11, 2019
Retrieved from "https://policy.appstate.edu/index.php?title=Accident_Reports&oldid=15131"