Policy 10-1-2: Accident Property Loss Injury Reports
|Policy:||Policy 10-1-2: Accident, Property Loss, Injury Reports||Date Adopted:|
|Statement:||Any WNC campus incident that results in injury/death, damage to State or personal property, crime or possible crime, or that may create a potential liability for the State must be reported. Provisions are included for filing a tort claim against the State.|
Table of Contents:
- Standard Reporting Forms
- Basic Accident Investigation Guidelines
Section 1: Introduction
- The WNC Public Safety Department is the key entity and primary contact for campus
incidents, accidents, vehicular accidents, injuries/deaths, potential liability reports,
property damage, theft or other possible crimes, and workers compensation reports.
All incidents, accidents, injuries, losses, and crimes or liabilities need to be reported
to Public Safety as soon as possible after they occur.
- Public Safety may delegate reporting and/or accident investigation to another WNC or Nevada System of Higher Education entity as appropriate.
- In general WNC Facilities and Planning Department completes NSHE Property Loss Reports; and WNC Environmental Health and Safety Department processes the initial workers compensation reports.
- Section 2 of this policy contains information on the specific forms and how to use them. Links to the forms are provided in this policy.
- Section 3 contains some helpful ideas on accident investigation and reporting.
Section 2: Standard Reporting Forms
- WNC Incident Report: This report is frequently used to document an incident; but it
is not a claim form. The Incident Report is designed for use on all accidents, injuries,
loss of personal property, theft or possible crimes, or suspicious activities. WNC
Public Safety should use this report when investigating an on campus incident.
- WNC Witness Statement: This form should be completed if you are involved in or witness
to an incident. It can be used with the WNC Incident Report. A copy of the completed
form should be sent to Public Safety.
- Workers Compensation Forms: Any eligible employee or volunteer must file a Notice
of Injury or Occupational Disease Incident Report (C-1) when a work related injury
or occupational disease occurs. The employees supervisor must sign the form and send
it to the EH&S Department. For additional information see WNCs Workers Compensation
Policy on the Environmental Health and Safety (EH&S) website at:http://www.wnc.edu/ehs/
The C-1 form can be found on the WNC EH&S website, under EHS Forms/Other link. From the list of EHS forms, select Workers Compensation Forms which will direct you to the BCN Workers Compensation Forms directory. The C-1 form will be listed as the Notice of Injury or Occupational Disease Incident Report. Contact Brian Crowe at EH&S for additional information on Workers Compensation.
- NSHE Property Loss Report (URM-003): The NSHE Property Loss Report is used to report
all WNC property losses; excluding State vehicle damage. A completed copy of the report
must be sent to Public Safety. The reporting department is responsible for sending
a copy of the report to BCN Risk Management for losses over $2,000 (which is the departments
- NSHE Vehicle Accident Report (URM-002): The NSHE Vehicle Accident Report must be completed
by the employee and their supervisor for all accidents within 48 hours of an accident.
The department must send a copy of the report to WNC Public Safety and BCN Risk Management.
If the accident involves a third party, a copy of the report must be sent to the Attorney
Generals Office as soon as possible (regardless if there is damage or injury). For
additional information contact Public Safety.
- NSHE Potential Liability Incident Report (URM 001): The NSHE Potential Liability Incident
Report should be used when an incident occurs that might result in liability on the
part of the NSHE (excluding vehicle accidents). This form needs to be completed and
submitted by the individual reporting the incident.This report is not a claim form. Send a copy of the report to WNC Public Safety. For more information contact Public
- Claim Against the State of Nevada: The Claim Against the State of Nevada form should
be completed by the party making a claim. Follow the instructions on the form. A copy
of the completed form should be sent to WNC Public Safety and the Attorney Generals
Office as soon as possible.
Section 3: Basic Accident Investigation Guidelines
- Put together an accident investigation kit if you do not have one. The kit should
contain the following items:
- Measuring tape
- Camera, film, flash
- Do-not-enter tape
- Investigating and Gathering Information:*
- Enter the accident scene cautiously.
- Ensure the injured are cared for properly before starting the investigation.
- Secure the scene to minimize the risk of further injury.
- Keep the accident scene as undisturbed as possible.
- If possible, take pictures of the scene or provide a diagram to describe the accident.
- Gather and record all evidence.
- Interview all persons involved (injured, witnesses, first aid attendant, supervisors, etc.).
- Be objective; do not begin the investigation with a fixed opinion.
- Set out the events in chronological order.
- Complete the WNC Incident Report.
- Submit a copy of the completed WNC Incident Report and all associated reports to the Public Safety Department for review and distribution.
- Correct any unsafe condition as soon as possible. Make sure temporary safety measures are taken whenever permanent or complete correction will require additional time.
- If you identify an unsafe condition that you can not completely correct or if you think it may be an OSHA or EPA violation, contact Environmental Health and Safety.
* Note: If the incident is a crime do not enter the incident scene without the sheriff departments approval.
|Date(s) Revised||September 2, 2008;||Date(s) Reviewed|