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Employee Accident, Incident and Near Miss Reporting

 

 

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detailed information on

Workers' Compensation

 

 

 

State of Texas Worker's Compensation Health Care Network

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Proper, accurate and timely reporting play a critical role in the investigation of an accident, incident, injury or near miss. The investigation and analysis of the event allows us to:

 

  • Identify the hazard/determine the cause
  • Develop a solution to prevent further injury/loss
  • Put the proper safeguards in place to prevent recurrences
 

Related policy and Forms

Workers' Compensation Policy - (02.A.25)

Medical care and treatment, and compensation for work related injury or illness

Supervisor Report of Accident

Required for all injuries whether the injury is minor or requires medical care.

(Must be completed and forwarded to Benefits Coordinator within 24 hours)

Witness Statement

If other individuals witness the incident/accident or other individuals have information regarding the incident/accident.

(Must be completed and forwarded to Benefits Coordinator within 24 hours)

Employee's Report of Injury (SORM-29)

For occupational injury, illness or exposure

(Must be completed and forwarded to Benefits Coordinator within 24 hours after DWS-1S is submitted)

Authorization for Release of Information Form (SORM 16)

If employee seeks medical care

(Must be completed and signed by employee and forwarded to Benefits Coordinator within 24 hours of the medical care)

Employee's Election Regarding Use of Sick and Annual Leave

Injured employee must choose whether or not they will utilize accrued sick leave and any annual leave before receiving workers' compensation income benefits.

(Must be completed and signed, employee and forwarded to Benefits Coordinator within 24 hours of the first full day of lost time.)

 

Reference SORM80 for additional Information.

 

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Procedures for an Injury

  1. For an injury that requires first aid, ensure the injured party receives any needed care and or first aid immediately. Make sure the individual is comfortable.
    For an injury that requires more than first aid, call the Police for outside urgent care at 8-911 or (713)221-8911.
  2. Notify your Supervisor and the EHS Office for all accidents, injuries or near miss incidents.
  3. Cordon off the area if needed. Do not remove anything, change anything or clean up until the investigation has been completed.
  4.

The EH&S Office will conduct an investigation immediately to determine if corrections or repairs are warranted to avoid additional or repeated harm to individuals or property.

  5.

If outside medical service is required, the Supervisor must:

      • Contact Employment Services Organization’s (ESO) Worker Compensation Coordinator,
      • Complete the “Supervisor Report of Accident)” form, and
      • Submit the completed form to ESO with a copy to the EHS Office.
  6.

If other individuals witness the incident/accident or other individuals have information regarding the incident/accident:

      • Each witness should complete a Witness Statement. and
      • Submit the completed form to ESO with a copy to the EHS Office.
  7.

If the injured employee requires outside medical care, he/she must:

 

  8.

If the injured employee seeks medical attention and/or has one full day of lost time:

      • Complete the “Witness Statement” form and submit it to ESO within 24 hours of the medical Care or full day of lost time.

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Reporting Injuries

If you or someone else is injured, seek immediate care. 

 
  • For minor injuries, go to the nearest First Aid Station on your floor or the Student Health Center located in the One Main Building, room N320
 
  • If urgent care is required, call or have someone call the UHD Emergency Number at 8-911 (713-221-8911) or go to a Yellow Emergency Call Box.

In either case, make sure the injury or near miss is reported to your supervisor and the EHS Office immediately.  This allows a timely investigation of the incident and facilitates the appropriate corrective action from the EHS Office.

 

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Reporting Hazard and Near Misses

A near miss is a warning to all that conditions are in place that could result in an injury. Do not wait until you or someone else has been injured.  When you become aware of any potential hazard, near miss or spill, immediately call the EHS Office at 713-221-8040 or 713-226-5526. Alternatively, forward an e-mail to ariase@uhd.edu.

If serious harm could result, immediately call Facilities Management at x8026 for clean up or repair.

 

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Page maintained by cookm@uhd.edu

Last updated or reviewed on 1/31/14

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