1520_Employee Accident

1520 Employee Accident Reporting

Washington County School District - Approved 10-11-05; revised 10-10-06

1. Purpose:

1.1. The purpose of this policy is to ensure proper procedure is followed in the event of an accident or an incident.

2. Policy:

2.1. All employees and volunteers shall report job related injuries, illnesses, and accidents (including vehicular accidents), regardless of severity immediately to the Principal, Administrator, or Supervisor, including:

2.1.1. Incidents and accidents where injury or illness occurs, as well as minor first aid or emergency attention are needed. First aid treatment is considered a one-time treatment of minor injuries that do not involve loss of consciousness or restriction of job duty.

2.1.2. Incidents where property or equipment damage occurs.

2.1.3. Any action or event observed that is unsafe or has the potential to cause injury or damage.

2.2. Washington County School District has worker's compensation insurance through the Utah School Boards Insurance Association. Injuries that occur on the job fall under this policy. The policy allows compensation for medical care. All employees (principals, teachers, custodians, food service workers, and bus drivers, etc.) have this protection.

3. Procedure:

3.1. Reporting medical accidents

3.1.1. First Aid and Emergency Medical Treatment. If medical attention is needed immediately, do to life or limb threatening accidents, the employee will:

3.1.1.1. provide reasonable assistance and take emergency medical measures, based on the employee's knowledge of such situations

3.1.1.2. call 911 as required for life or limb threatening injury immediately

3.1.1.3. report the incident to the principal or supervisor

3.1.1.4. call Company Nurse at 1-888-375-0279 (open 24 hours a day) to report a workplace injury

3.1.2. The principal or supervisor will report all injuries, even minor ones, to the District Risk Management Specialist within twenty-four (24) hours. Vital information and details may be lost or forgotten, if reports are not completed timely. Reporting of incidents or accidents should include the following details:

3.1.2.1. How the person or property was damaged, or has the potential for being damaged?

3.1.2.2. What happened at the time of the occurrence?

3.1.2.3. Were any safety procedures being used to avoid potential injury or damage to property?

3.1.2.4. Who witnessed the events that lead to the incident or accident?

3.1.2.5. What time and date did this occur?

3.1.2.6. List any other data that will assist in the investigation.

3.1.3. Principals, Administrators, and Supervisors must investigate all incidents or accidents under their jurisdiction, using the following forms: (refer to the worker's compensation accident binder for additional guidelines and for reports/forms to be completed):

3.1.3.1. Supervisor's Accident Investigation Report.

3.1.3.2. Employee Statement Regarding an Accident .

3.1.3.3. Witness Statement Form.

3.1.3.4. Labor Commission Report- Form 122.

3.1.3.5. IHC Work Med Authorization for Medical Treatment.

3.1.4. The Principal, Administrator, or Supervisor must complete the forms at the time of the accident, even if the employee or volunteer is not seeking medical attention at the time of the occurrence. A copy of the reports will be given to the District Risk Management Specialist, at (435) 673-3553 x113, within twenty-four (24) hours of the accident.

3.1.5. Initial care should be sought from Washington County School District's Medical Provider for Worker's Compensation, as provided on the employee referral cards:

IHC Work Med
385 North 3050 East
St. George, Utah 84790
(435)251-2630 3.1.6. Failure to obtain initial care from the District's provider could require the claimant to pay the cost of medical services related to receiving initial treatment from a non-designated provider. 3.1.7. After the claimant receives initial treatment from the District's designated provider, the claimant is allowed to make one change of doctor, after notifying the District Risk Management Specialist and the Worker's Compensation Insurance Provider. 3.1.8. Once a worker's compensation claim is filed, it now becomes the claim adjuster's responsibility to determine compensability. For claims to be compensable, they must meet the criteria of 1) It has to arise out of and 2) Be in the course of employment. Refer to the Utah Labor Commission's guide to Worker's Compensation for employers for more details. 3.1.9. At the time of initial medical treatment, post accident drug testing will be completed. Reference the Drug Free Work Place and Reasonable Suspicion District Policy 1400. 3.1.10. Washington County School District attempts to return the employee injured on the job to work within their physical restrictions as quickly as possible, using a Temporary Transitional Assignment, up to and including a maximum of twelve weeks. This may mean modifying hours worked, job duties, restriction of duties, and a temporary change of position or a combination of positions. The purpose is to temporally modify a position in order to meet the injured employee's restrictions until he or she can return to their normal routine. 3.1.11. If an injured employee is released by the treating doctor to perform modified work but refuses to return to work, notify the District Risk Management Specialist. All return to modified work must be documented with a Temporary Transitional Agreement form. Refusal by an employee to accept a temporary modified position could result in termination of worker's compensation benefits. 3.1.12. Depending on the work related injury restrictions, Transitional Duty with Restriction Forms (District form 224 ) may be completed by the Doctor providing care. The doctor will provide detail instructions on care, physical restrictions and special requirements. If an employee is unable to return to work, due to the severity of the injury, the employee may qualify for the Family Medical Leave Act. 3.1.13. An employee receiving worker's compensation benefits for lost wages may use accrued leave (sick time, personal time and/or vacation time) if available to help offset the difference between their average weekly wage (at the time of their accident or illness) and the benefit amount from worker's compensation, if they will accept a temporary modification of their position when: 3.1.13.1. The benefit alone is less than the employee's average weekly wage, or when, 3.1.13.2. The benefit, in combination with wages earned from a Temporary Modification of job assignment, is less than the employee's average weekly wage. 3.1.14. The injured employee will be contacted with in seventy-two (72) hours of the accident by the District Risk Management Specialist for follow up on their condition and throughout the course of the claims process. The District Risk Management Specialist will follow up with the Principal, Administrator, or Supervisor to ensure compliance with the injured employee's restrictions. 3.1.15. After each follow-up medical visit, due to an on the job injury, the employee must submit a completed Transitional Duty with Restriction Forms (District form #1) from the Doctor, indicating and changes in the work restrictions. It is the employee's responsibility to schedule any necessary return doctor visits and to provide documents for proof of continued restrictions. Adjustments to the modified job responsibilities may occur upon review of the Doctor's recommendations. A copy of the forms will be given to the District Risk Management Specialist for each doctor's visit. 3.1.16. In the event the employee does not return to work and is qualified for the Family Medical Leave Act (FMLA), the District will continue to fund the District's share of an employee's benefits during the employee's time off from work for authorized FMLA, due to the work related injury or illness. 3.1.17. When the employee's medical condition allows them to return to work, with no restrictions in regards to performing the essential functions of their job responsibilities, the Doctor will provide documentation that the employee is fit to perform their job with no restrictions, using the Physician's Fitness for Duty Release Form (District form 228 ). A copy of this needs top be provided to the District Risk Management Specialist.

3.2. Reporting district vehicle accidents (non-bus related)

3.2.1. Stop immediately. Leave vehicles as they are, unless you are told differently by a police officer.

3.2.2. Notify police of the location and if there are any injuries.

3.2.3. Take steps to prevent additional accidents.

3.2.4. Get names and addresses of witnesses.

3.2.5. Provide proof of insurance to police and other drivers.

3.2.6. Get the police case number.

3.2.7. Do not admit fault to anyone.

3.2.8. Get all the necessary information from the other driver.

3.2.9. All incidents and accidents need to have the proper investigation guidelines completed including (refer to the worker's compensation accident binder for additional guidelines and for reports/forms to be completed):

3.2.9.1. Supervisor's Accident Investigation Report


3.2.9.2. Employee Statement Regarding an Accident

3.2.9.3. Witness Statement Form

3.2.9.4. Labor Commission Report- Form 122

3.2.9.5. IHC Work Med Authorization for Medical Treatment

3.2.10. Notify the Risk Management & Benefits Specialist and immediate supervisor within twenty-four (24) hours.

3.2.11. If the vehicle cannot be driven, call for a tow truck. Do not allow anyone to move the district vehicle until transportation personnel arrive.

3.2.12. If you are injured and unable to fill out the proper forms, call or come to the District's Risk Management & Benefits Specialist office as soon as possible for paperwork processing. Remember, any and all accidents, no matter how minor, that involve a district vehicle must be reported.

3.3. Reporting property loss

3.3.1. The supervisor or secretary will report loss to the Business Administrator, in the event there is vandalism, theft, an act of nature, fire, of malfunction of equipment.
3.3.2. Contact the Business Administrator within twenty-four (24) hours.
3.3.3. Collect and send witness statements, police reports, and any other documentation to the Business Administrator.

3.4. Accident/Incident Investigation and Review (10-10-06)

3.4.1. The District Risk Management Specialist and an Administrator will meet and consider information related to an accident or incident. They will review employee injuries and accidents to determine if the event and actions leading to the injury or damage to property were preventable.

3.4.2. A preventable accident or incident is any omission, act, or conduct that includes unsafe, willful, reckless, or any violation of district policy. Preventable accidents also include an accident or incident that a reasonable person would have been able to avoid using district prescribed commonly or known safety precautions.

3.4.3. Willful or reckless conduct will be considered preventable and result in disciplinary action to include possible termination.

3.4.4. After the initial review of the incident, the District Risk Management Specialist will notify the employee within ten (10) days of receiving all relevant previous records, information, reports, and statements related to the accident/incident.

3.4.5. The Administrator, under the direction of the Human Resource Director, will follow District procedure for discipline in administrating recommendations for action from the accident/incident review.

3.4.6. Depending on the nature, severity and pervasiveness of an accident or incident was found to be preventable, the violation of safety compliance will result in any of the following levels of disciplinary action:

•    A documented verbal warning
•    A written warning
•    Probation, as established in District Policy 1450 or termination, to include non-renewal of contract

3.4.7. An Accident/Incident Review Board (ARB) composed of at least the Risk Management Specialist, one District Manager or Administrator, one classified or certified employee, and a member of the STS Committee. The ARB will meet at the request of an employee who wants to appeal the decision of the initial accident/incident review. The employee has the right to representation, review documentation related to the accident/incident, and the right to present additional information to the ARB. The employee’s representative will have the right to be present but not to vote in the ARB review.

3.4.8. The ARB shall hold a fact-finding meeting to determine if the accident/incident was preventable or non-preventable, or if negligence was involved.

3.4.9. The ARB shall report its findings and recommendations for actions to the Director of Human Resources. The Director of Human Resources will inform the employee of the findings within five (5) working days of the final ARB review.

3.4.9.1. The factors that are considered by the initial review and the ARB involve the category of severity of the accident/incident, history of past preventable accidents/incidents, employee conduct, preventability of the accident/incident, and any other relevant conditions, incidents, past safety violations, evaluations, training, and/or safety compliance issues.

3.4.9.2. The initial review and the accident review board will make a recommendation, as appropriate, related to the action that should be taken. The Director of Human Resources will follow District discipline policy and procedures in taking action or recommending action to the superintendent.

3.4.9.3. Additionally, mandatory refresher safety training and retraining may be required or suggested by the Risk Management Specialist in the initial review or accident review board’s final decision. Blocks of training may be assigned or suggested either alone or in conjunction with other disciplinary action taken.

Flow Chart - Initial Stages of an Injury Report

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