Accident Reports

Policy 303.5

1 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.

2 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.

3 Definitions

3.1 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.

3.2 EHS&EM

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

3.3 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.

3.4 Incident

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

3.5 In-Patient Hospitalization

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

3.6 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.

3.7 Occupational

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

3.8 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.

3.9 University

Appalachian State University.

3.10 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.

4 Policy and Procedure Statements

4.1 Worker's Compensation Benefits

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.

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.

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

4.2 Reports by the Occupational Safety and Health Office

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:

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.

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.

4.3 Non-Occupational Accidents

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.

4.3.2 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.

4.3.3 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.

4.4 Accident Report Form

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

4.5 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.

4.6 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.