Accident Reports

Policy 303.5

Introduction

All Appalachian State University employees are covered under the State Government Workers' Compensation Program. This includes full-time, part-time and temporary employees.

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.

Policy and Procedure Statements

Worker's Compensation Benefits

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.

1. 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.
2. 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.
3. 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.
4. 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.

Contact the Occupational Safety and Health Office at 262-4008 if you have questions.

Reports by the Occupational Safety and Health Office

North Carolina Occupational Safety and Health Standards require the recording and maintenance of the specialized reports of occupational injuries and illnesses as follows:

1. A continuously maintained log of each recordable occupational illness or injury reported to the Occupational Safety and Health Office.
2. An annual summary analysis of injuries and illnesses for public posting from February through April each year.

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.

Non-Occupational Accidents

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.

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.

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.

Accident Report Form

A copy of the Accident Report Form can be obtained from the University's Electronic Forms Web Site.

Supervisor's Accident Report Form

A copy of the Supervisor's Accident Report Form can be obtained from the University's Electronic Forms Web Site.

Employer's Report of Injury to Employee

A copy of I.C. Form 19 can be obtained from the University's Electronic Forms Web Site.

Revision Dates

Last modified 01/28/2011 03:27:31 PM by Matt McNaney