Employees are required
to report all accidents, injuries, or illnesses suffered during the course of
employment to their supervisors immediately. If the employee's supervisor is
not available, the affected employee must contact someone in his/her chain of
command. If no one in the employee's chain of command is available, the employee
is to notify the Human Resources Office (595-2204) or the Safety Coordinator
(595-2262.) Similarly, when an employee is required to notify his/her supervisor
of work restrictions, medical status, etc., and the supervisor is not available,
the employee shall use the same notification method as above.
Outside of normal business
hours, work related accidents, injuries and illnesses must be reported to University
Police. For serious accidents, injuries or illnesses outside normal business
hours call the University Police emergency number, 595-2911. For minor accidents,
injuries, and illnesses use the University Police business line, 595-2455. Outside
normal business hours, employees may obtain accident forms at University Police,
Room 188, Tallent Hall. Employees must still notify their supervisors of the
accident, injury or illness within 24 hours or as soon as practical given the
These procedures clarify
the steps to be taken in the event that a University of Wisconsin-Parkside employee
suffers an accident, injury or illness while in the course of their employment
with the University. Additionally, these procedures are meant to clarify the
responsibilities of employees, supervisors and other University officials as
related to accident, injury, and illness reporting requirements.
1. Notify supervisor of
accident, injury, or illness immediately. Outside normal business hours, report
the accident, injury or illness immediately to University Police as outlined
2. Employee must complete
and submit to his/her supervisor the "Employee's Work Injury and Illness Report"
form within 24 hours of being injured or becoming ill.
3. Employee must inform
his/her supervisor if the injury or illness will result in any absence, including
the anticipated length of absence, as soon as possible.
4. If the employee will
be absent 3 days or less, the employee must call the supervisor each day to
report that he/she will not be in to work that day.
5. If the employee will
be absent more than 3 days, the employee must provide a written doctor's excuse
to the supervisor as soon as possible, and must call in each day until a doctor's
excuse is provided. The employee should have the doctor's office fax the written
work excuse to Human Resources at 595-2206.
6. Prior to reporting to
work with restrictions, an employee must provide a copy of the work restrictions
established by the treating physician to his/her supervisor.
7. Any time work restrictions
change, the employee must provide a copy of the new work restrictions to the
supervisor prior to reporting for work.
8. When an employee is
out for more than one week, the employee is required to contact the supervisor
at least once each week on the first day of the work week. Such contact may
be in person or by telephone and will be for the purpose of updating the supervisor
as to the employee's condition and anticipated return to work date with or without
9. Prior to returning to
work after being out for more than one week, the employee must notify the supervisor
at least one full working day before the employee intends to return to work
with or without restrictions.
10. Prior to returning
to work without restrictions, after having had work restrictions in place, the
employee must present a work release from the treating physician to the supervisor.
1. Notify Worker's Compensation
Coordinator (x2256) immediately upon being notified of an accident, injury,
or illness. The WC Coordinator will determine which reporting form(s) will be
need to be filled out and whether the Safety Coordinator should respond.
2. Conduct accident investigation.
Gather facts, interview employee, interview witnesses, if any, and determine
the primary and secondary causes of the accident. If needed, seek assistance
from the Safety Coordinator.
3. Complete and return
the reporting form(s) to the WC Coordinator within 24 hours of receipt. Hand
deliver if delivery by campus mail will not be within the 24 hour time frame.
Note: The 24 hour requirement does not apply to "Employee / Supervisor Short
Form Injury Report."
4. Inform employee of his/her responsibilities as listed above, and ensure that the employee fulfils those responsibilities. If the employee does not fulfil his/her responsibilities it is the supervisor's responsibility to contact the employee and reiterate the requirements. Continued failure to meet requirements is justification for disciplinary action.
5. Forward copies of all
doctor's excuses and work restrictions to the WC Coordinator as soon as possible.
6. Participate on the Early
Return to Work Team if the employee's injury or illness results in work restrictions
for an extended period of time.
1. Receive accident notifications
from supervisors and determine which reporting form(s) need to be filled out
and whether the Safety Coordinator should respond to investigate.
2. Inform Safety Coordinator
of all work related accidents, injuries, or illnesses. Contact Safety Coordinator
immediately in the event of a serious accident, injury, illness, or when there
has been a back injury or repetitive motion injury.
3. Maintain all accident reporting records. Send copies to Safety Coordinator and UW-System Worker's Compensation office as required.
4. Follow-up with doctors,
supervisors and rehabilitation nurses regarding work excuses, restrictions,
and employee's medical status.
5. When needed, counsel
employees regarding WC benefits, leave matters, and income continuation insurance.
6. Complete "Employer's
First Report of Injury or Disease," DWD Form "WKC-12" when it is likely that
a work related injury or illness will result in more than 3 lost work days.
7. Participate on the Early
Return to Work team.
SAFETY COORDINATOR RESPONSIBILITIES:
1. Respond to, and immediately
investigate, all serious accidents, injuries and illnesses and to those that
involve back injuries or repetitive motion injuries.
2. Review all accident
reports, enter cause and occurrence codes, and complete the "Safety Coordinator's
3. Analyze accident trend
data and make recommendations for corrective actions.
4. Manage the University's
Early Return to Work Program and participate on the ERTW team.
5. Provide assistance to
employees, supervisors, and the WC Coordinator as needed.
The following forms are
available from the Human Resources Office and/or Safety Coordinator.
1. Employee's Work Injury and Illness Report
2. Employee / Supervisor Short Form Injury Report
3. Supervisor's Accident Analysis and Prevention Report
4. Safety Coordinator's Review
5. Employer's First Report of Injury or Disease (DWD Form WKC-12)
6. Injured Employee Responsibilities
7. Supervisor Responsibilities