Any accident, injury, or work-related illness,
or on-the-job incident which could have
caused an injury or illness, must be reported
to the Department of Environmental Health
and Safety (EH&S). This reporting ensures
that comprehensive records are maintained,
legal requirements are met, and corrective
action is initiated to prevent future incidents.
b.
How
to Report
All reportable occurrences should be recorded
by preparing and submitting EH&S's
Accident/Incident Report form within 24 hours
following the accident. University of Washington
Medical Center (UWMC) and Harborview Medical
Center (HMC) units should use the Supplemental
Incident Accident Report (SIAR) form.
When an accident involves a visitor, student,
or other non-employee, the facility manager
or event coordinator should fill out this
form.
c.
Worker's Compensation
Program
University employees and volunteer workers
whose injury or illness occurred as a result
of employment are eligible for Worker's Compensation
coverage and benefits. Further questions
regarding benefits and responsibilities of
the Worker's Compensation Program can be
answered by contacting EH&S, 206–543–0467.
If an on-the-job injury or illness occurs,
the employee or volunteer may go to the physician
of his or her choice. The State Department
of Labor and Industries (L&I) Accident Report
must be completed to initiate the claim.
The University's internal Accident/Incident
Report form or the SIAR form must also be
completed.
1)
L&I
Accident Report Form Preparation—The
three parts of this form must be completed
by the employee, physician, and EH&S.
a)
The
Employee or Employee's Representative—The
employee or employee's representative should
inform the physician that the incident
is work related and probably will be covered
under Worker's Compensation. The physician
will provide a L&I Accident Report form;
the injured worker's section should be
completed by the employee or, if the employee
is incapacitated, by the physician or physician's
agent.
b)
The Physician—After
the employee is examined and treated, the
physician will complete the physician's
section of the L&I Accident Report form
and send the original of this and the injured
worker's section to L&I. The physician
will then send a copy of the physician's
and injured worker's section, and the entire
employer's section, to EH&S.
c)
The Department
of Environmental Health and Safety—EH&S
is the only unit authorized to complete
and sign the employer section of the L&I
Accident Report form. Note: If the employee's
department receives the L&I Accident Report
form, it should be forwarded to EH&S
for proper completion and disposition.
2)
Further
Coverage After Case Closure—If
further treatment is required after a
claim has been officially closed by L&I,
the claim must be reopened by the employee
and the physician at the time of treatment.
To ensure coverage the employee should
inform the physician of the claim's status,
including the claim number, at the time
of further treatment.
d.
Special
Insurance Coverage for Accidental Injury
or Death
Participation as a human
subject in University-sponsored research
projects and travel in a nonscheduled
aircraft may be covered by special insurance.
Special reporting requirements and/or
claims procedures are described in Administrative
Policy Statement 14.1.
Information Which Should be Obtained at the
Time of an Accident
The following information will be
necessary in making reports and should be obtained at the
time of the accident, if possible:
Names of owners (and drivers, if not the
same as "owners"), as well as license and vehicle
ID numbers of cars involved.
Date and approximate time of accident.
Place of accident (nearest town or city, county,
and state).
Name of police officer and his or her badge number.
Names and addresses of as many witnesses as possible.
Description of damage to any other vehicles involved.
Details of accident, i.e., direction and speed
of cars involved, weather and road conditions,
whether a summons was issued, and if so, to whom.
b.
Vehicle Accidents Occurring
on University Property
Immediately notify the University
Police, 206–543–9331, and an officer will come
to the scene to evaluate the extent of the damage.
1)
Accidents
Resulting in Injury, Fatality or Significant Damage—If
the accident results in an injury, a fatality, or damage
to the property of any one owner to an apparent extent
of $500 or more:
Each driver involved in the accident must file
a state of Washington Motor Vehicle Collision Report
form with the University Police within 24 hours
after the accident.
The investigating officer will complete a state
of Washington Police Traffic Collision Report form.
2)
Other Requirements—Other
requirements applicable in the following situations:
If a University-owned
vehicle is involved, a
state of Washington Vehicle
Accident Report form must
be filed with the University
Police. Forms and instructions
for reporting accidents
are kept in the glove compartment
of University-owned vehicles;
forms may also be obtained
from the University Police.
If an injury is involved,
see Section 1 of this policy
statement to determine
whether any specific injury
reports must also be filed.
c.
Vehicle Accidents
Occurring Off University Property While Conducting University
Business
The following requirements apply to
University-owned, leased, or privately-owned vehicles:
1)
Accidents Resulting
in Injury, Fatality or Significant Damage—If
the accident results in an injury, a fatality, or damage
to an apparent extent of $500 or more, file a Motor Vehicle
Collision Report form with the nearest police agency
having jurisdiction for the accident site within 24 hours.
2)
All Accidents—File
a state of Washington Vehicle Accident Report form, with
the University Police. Forms and instructions for reporting
accidents are kept in the glove compartment of University-owned
vehicles, and may also be obtained from the University
Police.
