Resident and Fellow Policy Manual
Appendix 1 - Incident Reporting (Environmental Health & Safety and Worker's Compensation):
When a work-related incident, injury, or illness occurs, please document the event via one of the following two options:
Be prepared to provide the following information:
- Employee name/social security number/employee ID #
- Date of accident/location where accident occurred
- Time employee began work and the time the injury occurred
- Excluding the date of incident, provide the dates the employee will be absent from work due to this injury/illness (estimate if unknown)
- Typical work schedule for injured employee
- Information regarding injury/exposure; nature of injury and body part affected, what employee was doing when injured, how did the incident occur, what the object or substance was that directly injured employee; what corrective action was taken
- The type and brand of sharp (needle/blade) involved in a contaminated sharp injury (an OSHA requirement)
- Was medical care provided to the injured employee? If yes, when, and the name and address of doctor and/or hospital
- Date the supervisor/employer was first notified of incident
Additional questions regarding procedures may be directed to the Workers’ Compensation Office at 275-7250 or visit the web site http://www.safety.rochester.edu/workcomp/workcomp.html
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