Accident, Injury, Illness Reporting Procedures Policy
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
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Any time work restrictions change,
the employee must provide a copy of the new work restrictions to the supervisor
prior to reporting for work.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- Inform employee of his/her responsibilities
as listed above, and ensure that the employee fulfills those responsibilities.
If the employee does not fulfill 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.
- Forward copies of all doctor's
excuses and work restrictions to the WC Coordinator as soon as possible.
- 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
- 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.
- 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.
- Maintain all accident reporting
records. Send copies to Safety Coordinator and UW-System Worker's Compensation
office as required.
- Follow-up with doctors, supervisors
and rehabilitation nurses regarding work excuses, restrictions, and employee's
- When needed, counsel employees
regarding WC benefits, leave matters, and income continuation insurance.
- 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
- Participate on the Early Return
to Work team.
SAFETY COORDINATOR RESPONSIBILITIES:
- Respond to, and immediately investigate,
all serious accidents, injuries and illnesses and to those that involve back
injuries or repetitive motion injuries.
- Review all accident reports,
enter cause and occurrence codes, and complete the "Safety Coordinator's Report."
- Analyze accident trend data and
make recommendations for corrective actions.
- Manage the University's Early
Return to Work Program and participate on the ERTW team.
- 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.
- Employee's Work Injury and
- Employee / Supervisor Short Form
- Supervisor's Accident Analysis
and Prevention Report
- Safety Coordinator's Review
- Employer's First Report of Injury
or Disease (DWD Form WKC-12)
- Injured Employee Responsibilities
- Supervisor Responsibilities