University of Wisconsin-Parkside
Accident, Injury, Illness Reporting Procedures Policy
Policy #67

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 employee's condition.

PURPOSE:

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.

EMPLOYEE RESPONSIBILITIES:

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 above.

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 restrictions.

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.

SUPERVISOR RESPONSIBILITIES:

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.

WORKER'S COMPENSATION COORDINATOR RESPONSIBILITIES:

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 Report."

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.

FORMS:

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