SMALL AGENCY EXTERNAL BUSINESS PROCESS
Accident/Incident Report Process
Small Agency HR Services
Responsible Action Item
Employee Report accident/incident to their supervisor.
Supervisor Call Department of Enterprise Services (DES) Small Agency Safety Consultant
at (360) 407-8414 to report accident/incident.
Supervisor Complete and submit the Small Agency Accident/Incident Report form to DES’s
Small Agency Safety Consultant within two (2) working days.
Supervisor Retain a copy of the Small Agency Accident/Incident Report form for their
Supervisor Submit the electronic form to the Small Agency HR Services mailbox
DES Small Agency Redact personal information from form.
DES Small Agency Provide redacted copy to the Safety Committee for review.
Supervisor If agency receives an L&I claim resulting from the accident, complete the
employer section of the claims form and submit it to L&I.
Supervisor Notify DES Small Agency Safety Consultant that an L&I claim has been opened.
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