Employee Environmental, Health & Safety Manual
ACCIDENT REPORTING & INVESTIGATION PLAN
Prepared by: Cynthia Eghbalnia, Campus Safety & Security Manager
Latest Revision: 03/11/07
Note: Print document as needed for MATC Departmental purposes; it is user responsibility to ensure use of latest revision by
checking online at: http://matcmadison.edu/ad/facilities/EHS/ under “procedures and services”.
Scope and Application
Attachments: A: Accident/Incident Report Form
The purpose of this plan is to provide specific methods and practices for reporting and
investigating accidents that can be read and understood by all managers, supervisors, and
employees. This plan addresses the reporting and investigation of accidents or work
conditions that caused or reasonably could have resulted in injury, illness, or property
damage. Reporting and investigation is required in order that:
• Cause may be identified and, if appropriate, corrective action initiated to prevent a
• OSHA reporting and recordkeeping requirements can be met
• Insurance notification requirements can be met
II. SCOPE AND APPLICATION
The requirements of this plan apply to all operations and departments at the college, or on
college-related work and study activities.
All District related accidents should be investigated. The depth and complexity of the
investigation will vary with the circumstances and seriousness of the accident. The
Supervisor, or other designatee responsible for operations involved in an accident, should
ensure that an investigation is conducted and when appropriate, corrective actions are
An accident is defined as an incident or event occurring at the District work/school site,
or while on District business, that caused or reasonably could have caused injury to
personnel and/or damage to equipment or facilities.
Risk Management Office
1. Reviews reports, forwards to Campus Safety & Security and to HR as appropriate.
2. Notifies Insurance Company representative of any accident warranting risk
3. Maintains copy of reports received.
Campus Safety & Security Manager
1. Reviews Accident Reports as received from the Risk Manager’s Office, and
follows up as deemed necessary.
2. Maintains a permanent file of accident investigations and reports obtained through
the Campus Safety & Security Office.
3. Reports information on a serious injury of death to Department of Commerce
officials, as required by law.
4. Provides a summary of the accident summary to the District Safety Committee for
their review, comments and follow-up requests.
5. Provides training in investigation methods and techniques to Supervisors, when
6. Provides general awareness information to all staff of these procedures.
7. Evaluates the plan for revision and update needs periodically.
1. Completes and forward to worker’s compensation insurance carrier the
Employer’s First Report of Injury or Illness.
2. Maintains OSHA Form 300 and copies of the Employer’s First Report of
Occupational Injury of Illness.
3. Posts the OSHA 300 log, as required by law, annually.
1. Ensures that employees report each on-the-job injury (and students report each
District related injury) and damage to equipment or facilities.
2. Participates in accident investigation; completes and submits the supervisor’s
Accident Investigation report to the Risk Manager within 24hours.
3. Ensure corrective actions identified in the accident investigation are incorporated.
1. Report each school-related accidents/incidents and damage to equipment of
facilities to their supervisor.
V. GENERAL PROCEDURE
1. All school-related accidents/incidents (staff, student, visitor, athlete, etc) require
Sections I and II of the MATC Accident/Incident Report to be completed by the
injured person. If unable to do so, the person supervising the activity is to
complete the accident report.
2. In all cases, the supervisor of the activity is to complete Section III (instructions
discussed in more detail in the next section) on the Accident/Injury Report Form,
review the report for completeness and accuracy, sign and forward to the Director
of Finance/Risk Manager within 24 hours of the accident/incident. Note: a fax or
PDF (followed up by the receipt of the original form) is acceptable form of
submittal in order to ensure the 24 hour compliance requirement.
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3. Risk Management Office:
• Receives form and reviews each for awareness; advises DMI if needed.
• Sends copy to Campus Safety & Security (EH&S or Security)
• Forwards copy, if employee related, to HR
• Files/follows-up as needed
4. HR Office:
• Receives form and completes Employee First Report of Injury; files with
Insurance Company for Worker’s Compensation, where appropriate.
• Submits form to DMI
• Completes OSHA 300 log, where applicable
• Files/follows-up as needed
5. Campus Safety & Security (EH&S Office or Security)
• Receives form and follows-up on investigation action as needed
All accidents, regardless of apparent degree of severity, must be reported to the
employee’s supervisor (or in the case of a student/visitor, to the appropriate MATC
contact). In the case where there are no identified MATC contact (i.e., injury
happened unrelated to a classroom activity or shop area) accidents should be reported
to the MATC Security Office (Truax, room 117) or Campus Administrator’s Office
(if other than Truax).
Any employee witnessing an accident at work is to call for emergency help or
whatever assistance appears to be necessary. In addition, the employee is immediately
to report the accident to his or her supervisor and take part in answering questions
related to the Accident Report and Accident Investigation.
Accident Investigation Procedures
The first priority whenever an accident occurs is to deal with the emergency and
ensure that any injuries or illnesses receive prompt medical attention. The accident
investigation should begin immediately thereafter. This ensures that details of what
occurred will be fresh in people’s minds and that witnesses don’t influence one
another by talking about the accident. It also minimizes the likelihood that important
evidence is not moved, lost, taken, destroyed, or thrown away before the scene has
been thoroughly inspected.
1. Who Should Investigate
Supervisors should note initial details of the incident, and contact Campus Safety
& Security Manager for assistance in the process if needed.
Regardless of the type of investigation, the supervisor should be involved for the
Supervisors have a responsibility to provide their employees with a
safe and healthful workplace;
Supervisors know the employees (or students) and their work
better than anyone else and are in the best position to gather the
facts and find a practical solution to the problem;
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The supervisor’s involvement can help promote better relations
with workers by demonstrating concern for their safety and
attention to accident prevention.
2. Accident Investigate Approach
As with most other tasks, skill in conducting effective accident investigations
improves with experience. A good basic approach is to find out what caused the
accident and what can be done to prevent or minimize the chances of a similar
accident occurring. Some suggestions that may help supervisors get the facts and
reach a conclusion include:
Maintain objectivity throughout the investigation. Its purpose is to
find the cause of the accident, not to assign blame for its
Check the accident site and circumstances thoroughly before
anything is changed.
Discuss the accident with the injured person, but only after first aid
or medical treatment has been given (see Section A1, Work-
Related Injuries and Illnesses). Also talk with anyone who
witnessed the accident and those familiar with conditions
immediately before and after it occurred.
Be thorough. Small details may point to the real cause.
Reconstruct the events that resulted in the accident, considering all
possible causes. Determine unsafe conditions or actions that
separately or in combination were contributing factors.
3. What To Do With The Results
Supervisors should take action to control or eliminate the conditions that caused
the accident once these have been conclusively identified. Campus Safety and
Security can provide assistance in determining the level of action that may be
necessary, such as the following:
When equipment changes or safeguards are necessary, supervisors
should discuss specific recommendations with their
When an operation can be changed to eliminate the hazard,
supervisors should make the change if it is within their authority,
or seek the necessary approval from the Administration budget
If unsafe acts by workers are involved, ensure that the worker is
properly trained and that training is followed. All others involved
in similar operations should be trained as well.
Note: the accident investigation report is used to:
Track and report injuries on a monthly basis;
Group injuries by type, cause, body part affected, time of day, and
Determine if any trends in injury occurrence exist and graph those
trends if possible;
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Identify any equipment, materials, or environmental factors that
seem to be commonly involved in injury incidents;
Discuss the possible solutions to the problems identified with the
safety team and superiors;
Proceed with improvements to reduce the likelihood of future
This plan is an internal document guiding the action and behaviors of employees,
so they need to know about it. To communicate the new accident reporting and
investigation plan, all employees are given a thorough explanation as to why the
new plan was prepared and how individuals may be affected by it.
The information and requirements of this written plan are presented to employees
during new hire orientation or as the plan is reviewed and modified but at least
Revised 3/11/07 (C. Eghbalnia)
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Accident/Incident Report Form
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