Procedure: Reporting a Work-Related Injury Or Illness

Procedure: Reporting a Work-Related Injury or Illness

1. Managers/supervisors areresponsible for educating all employees on the proper reporting procedures and the importance of reporting all incidents/accidents in a timely manner.
2. Any employee (manager or other) who is the first to witness an accident should quickly access the situation:
3. Secure the incident location; ensure that access is limited to others and that there is no additional potential for injury
4. Call 911 or identify an individual to call 911 if medical attention is required
5. Locate a first responder to provide guidance and/or first aid if applicable. (see attached list)
6. Notify your manager/supervisor of the work related injury or illness
7. Be mindful of any employees that may have witnessed the incident
8. Once notified of the incident, if not the first at the scene, the manager/supervisor should quickly access the situation again as outlined in Step 2.
9. Once the injured employee has been attended to, the manager/supervisor must notify Human Resources and Georgi Diamond immediately
10. If the accident/incident involves a vehicle, the manager/supervisor must notify Dave Griessler, Fleet Manager who will notify the insurance carrier.
11. The manager/supervisor must make arrangements to have the post-accident drug screening; the post-accident drug screening is most accurate when performed within two (2) hours of the actual incident and should be scheduled as such.This is required for ALL accidents.
12. If the employee is injured to the point in which they will need to go to a medical facility, the drug screening should be completed by that facility
13. If the employee does not need medical attention, they will need to be sent to Northeast Testing Upstate, Inc. You will need to call in advance to let them know that the employee will be coming and inform them that it is a post-accident screening. If you do not feel the employee should be driving, make arrangements to have someone drive the employee to the testing center.

Northeast Testing

21 Everett Road Ext.

Albany, NY 12205

Phone: 518.618.1255

1. In some situations, Northeast will send a representative to the accident site or one of our locations to perform the screening.

1. Georgimay visit the location in which the accident occurred to take a report and pictures. Manager/supervisor should partner with Georgi to complete an investigation.
2. Manager/supervisor must complete the C2, NYS required accident reporting form, within 24 hours of the incident. Please be sure to be as specific as possible in the description of the incident. The form can be completed electronically to ensure legibility and printed to provide your signature.
3. Upon completion, the manager/supervisor must send the form to Human Resources to process and report as required. Manager/supervisor should finalize the investigation: Determine route cause and develop a plan of action including corrective actions and communications to other locations and managers. For guidelines on completing the investigation, please refer to the “Incident Investigation” document.
4. When finalized, the manager/supervisor should send investigation to Human Resources. This should be completed within 48 hours of the accident. Important: the information in the investigation can be helpful to other departments within the company and ultimately prevent a similar accident from occurring.

*Please contact Human Resources if you have any questions or require assistance.

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Please direct all billing for work related incidents to the following:

Carver Companies

Karin Bourassa, PHR

Human Resources Manager

494 Western Turnpike

Altamont, NY 12009

#518.355.6034

First Responders:

Accident/Incident Investigation & Communication:

“Accidents occur by “chance”, incidents occur because something did or did not happen (root cause).

All good safety systems include an incident investigation program to help capture all the facts surrounding the situation, so that the “root cause” can be identified and steps can be taken to prevent the same incident from happening again.

1. There are 4 types of Incidents that need to be investigated:

“Near Miss”: A situation where no injury actually occurred but that could have resulted in an injury. (Example: Someone tripped and fell but did not get hurt).

“First Aid”: An injury that is treatable by basic first aid either internal to the plant or by outside medical personnel. (Example: minor cut, bruise, or abrasion).

“Recordable”: An injury requiring more advanced treatment by outside medical personnel. Example: Broken bone, stitches, prescription medication etc.

“Lost Time”: An injury requiring time away from work. Example: Back injury, surgery etc.

1. When should the Investigation take place?

• As soon as possible after the event
• No later than 48 hours.

The faster the investigation is conducted, the greater the chance of accuracy and getting the real picture of what happened.

1. Who Investigates?

• All employees directly involved.
• Immediate Manager/Supervisor.
• Safety Officer.
• Witnesses.

1. A good investigation should determine:

• What exactly happened?
• Who it happened to?
• Where it happened?
• When it took place?
• Why it happened?....Root Cause?...CRITICAL!

1. Finding the Root Cause.

• Always have everyone involved on the investigation team- add “experts” as needed such as maintenance technicians.
• Be objective - don’t let personal opinions get in the way of the actual facts- NEVER ASSUME ANYTHING!
• Take photos for later analysis (especially items which may not remain such as spills, tracks, footprints, tools, parts, equipment etc.)
• Collect all related documents such as training records, work place inspections etc.
• Do not move anything at the scene until the root cause is determined.
• Reconstruct the incident if it is safe and practical.

Always provide medical treatment to those injured FIRST, before conducting an investigation!

1. Who gives final approval to the report?

• Employee’s Supervisor
• Human Resources

1. What happens to the report?

• The report findings will be communicated internally through a “Safety Alert” email and posted on safety notice boards so that all location employees are aware of what happened.
• The report will also be communicated at the next weekly toolbox meeting.
• Based on the report findings an action plan will be developed that identifies any engineering, training or administrative controls that are needed to prevent this incident from occurring again in the future.

1. Agency Notifications

Any required filings of the incident with government agencies such as OSHA or MSHA will be handled by the Human Resources within the regulated government timelines and using the mandated forms. The “Safety Incident Reporting Form” is intended for internal use only.