Samples of Writing Incident Report - DOC by qco11598

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									(Sample from the YVC of King County, Seattle, WA)

Accident/Incident Report Procedures
Sometimes serious events take place in the course of youth programming and agency management that
require a system of tracking. Writing an Accident/Incident Report helps our agency deal with complaints,
accidents, emergencies, and other risks to our reputation and resources.

When NOT to Write an Accident/Incident Report

Staff do not need to write an Accident/Incident Report for:
    1. routine health treatment in a camp setting (day camp, resident camp, or Camp Fire program
         event) when that treatment is recorded in the Health Log AND none of the criteria listed below are
         met. For example, a camper gets a minor cut, so the first aider in charge follows the approved
         care procedure and logs the event in the Health Log. This does not require that an
         Accident/Incident Report be completed as well.
    2. a complaint that is minor and can be immediately resolved to everyone’s satisfaction, such as a
         billing mistake or clerical error.

When to Write an Accident/Incident Report

Staff in charge should write, or help a volunteer leader to write, an Accident/Incident Report to document
any event that:
         1. requires a 911 call, police report, crisis clinic, or CPS call
         2. causes a participant, volunteer or employee to be referred for outside medical attention
         3. causes a participant, volunteer or employee to be shocked or potentially harmed
         psychologically, or would be an event a parent would reasonably need or want to know about
         their child experiencing
         4. causes a participant, volunteer or employee to be suspended or discharged from a program or
         position (you must have the CEO’s permission to send someone home permanently).
         5. might result or has resulted in a complaint call/e-mail/letter to the CEO, a staff member, the
         media or National Camp Fire
         6. might jeopardize the reputation of the agency, its programs, or staff or volunteers
         7. might lead to a lawsuit against Camp Fire
         8. will cause Camp Fire to file a medical, property, or other type of insurance claim
         9. causes Camp Fire’s or someone else’s property to be damaged
         10. might cause or does cause Camp Fire to file an L&I claim

If in doubt about whether to submit an Accident/Incident Report, consult your supervisor for guidance.

Call First!
     Call Your Supervisor for Support
        Everyone handling an incident or upsetting event deserves support during and after it has taken
        place. If you have not already conferred with your supervisor, do so. If your supervisor is not
        available, call the COO.

       Notify the CEO in Serious Situations – Items above # 1-7
        In case of a serious incident (an injury accident, major incident, or legal or public perception
        threat to the organization) a call to the CEO is required. If you are unable to reach the CEO, the
        COO or your manager to call the CEO, but make sure the CEO is notified by one of these means
        early in the situation.

       Notify the Manager on Call in Serious Situations

c3b74490-fb6c-4b70-90a3-db9f371dc02a.doc                                                       1/09
        In cases when there is a significant injury or incident and the authorities have been called, also
        notify the Manager on Call with the Management Pager. That way, if authorities or other family
        members need to reach the people involved, the Manager on Call can help facilitate this.

Which form to use
The initial report should be written on either 1. the white 3-part NCR Incident Report form, or a copy of
it. If using a copy, make multiple copies, keeping one for your records, OR 2. the electronic version of
this that can be completed as a form in Word found in the S:\Forms\Accident & Incident Forms.

Some incidents require investigation and follow-up with affected parties. These contacts and their results
need to be documented as well, so that there is a complete record of what has been done to address the
situation. Use the green Follow Up form for documenting these conversations and next steps.

What to Write when Preparing an Incident Report
Record the who, what, where, how of the incident in objective, factual language. You are writing a
document that could be used in a legal proceeding, so just write the facts. Be complete. Use extra paper
if needed. Observations of the state of participants are important, such as, “When the parent picked up
the child, they smiled and said thank you to me for Counselor Froggy’s expert handling of the situation.
They stated that Camp Fire is the one place they know their child is well cared for.”

When to Submit
Incident Reports must be submitted 24 hours or less after the event for the initial report. Follow-up
reports (green), if needed for investigations or concerned check-in, should follow in less than 3 working
days, unless you have been granted an extension by the Chief Operating Officer.

How to Submit an Incident Report
Fax, e-mail to the Chief Operating Officer.

What happens next – how Incident Reports are handled internally

For serious incidents, the COO will check with the CEO immediately to make sure she has been notified.
In addition, if the situation is unclear, we will form a support team to investigate what happened,
documenting as we go.

L&I Claims
Anytime a staff member is injured at work, or becomes ill as a result of required work activities, it needs to
be claimed under the Washington State Department of Labor and Industries Workers’ Compensation
Insurance. When you receive medical care in these instances, clearly explain to the medical provider that
it is an L&I claim. They have the appropriate paperwork and will forward the necessary documents to HR.
In addition to the L&I paperwork completed at the hospital/clinic, you must also complete:
                  ~An Accident/Incident Report within 24 hours
                  ~Submit the receipt and prescription label for all resulting prescription medication to
                  Dana, the HR Specialist.

Mutual of Omaha Insurance Claims
Camp Fire program activities are covered by Basic Accident Insurance and Resident Camp Insurance. If
a camper/participant/volunteer gets injured while participating in a Camp Fire USA event or program and
requires medical attention as a result, the medical establishment should bill Camp Fire USA. When this
happens, the HR Specialist will submit a claim to Mutual of Omaha.

If a parent takes their child to get treated for an injury sustained during a Camp Fire program, they can be
reimbursed through our Accident or Camp insurance and should contact Camp Fire’s HR Specialist. If the
hospital/clinic knows to bill Camp Fire, then they will send the charges directly to the HR Specialist. Staff
must still complete for these situations:
                  ~An Accident/Incident Report within 24 hours

c3b74490-fb6c-4b70-90a3-db9f371dc02a.doc                                                          1/09
                 ~Submit the receipt and prescription label for all resulting prescription medication to
                 Dana, the HR Specialist.

c3b74490-fb6c-4b70-90a3-db9f371dc02a.doc                                                          1/09

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