Environmental Health and Safety
Incident and Accident Reporting and Investigation
Revised: September 12, 2018
Outline
- Purpose
- Definitions
- General Reporting Guidance
- Electronic Submission of Forms
- Specific Reporting Requirements
- Summary
Purpose
- Ensure compliance with State of Louisiana Office of Risk
Management (ORM) requirements for incident and accident reporting and
investigation.
- Determine the root cause of incidents and accidents so that
action may be taken to reduce the likelihood of re-occurrence.
- Note that hyperlinks are used in this training. Use them to
access more detailed information.
Definitions
An Incident is an unplanned
or "near-miss" event that could have caused personal injury or property
damage.
An Accident is an undesired
event that results in personal injury or property damage. Even "minor"
injuries (cuts or sprains) are considered accidents.
A Motor Vehicle Accident is
any incident in which the vehicle comes into any contact with another
vehicle, person, object, or animal that results in death, personal
injury, or property damage, regardless of: who was injured, what was
damaged or to what extent, where it occurred, or who was responsible.
General Reporting Guidance
- Report all incidents and accidents, no matter how minor.
Performing a root cause analysis on a "near miss" or an accident can
provide valuable information that could prevent a future accident.
- The state directs the use of three forms for reporting:
- DA 2000, Employee Post Incident or Accident
Analysis - - for
employees.
- DA 3000, Visitor /Client Post Incident or Accident
Analysis - - for
visitors, contractors and students.
- DA 2041, Louisiana State Driver Safety Program
Accident Report
- - for employee vehicle accidents while driving on official business.
- Submit reporting forms within five calendar days. The exception
is for vehicle accidents; they must be reported within 48 business hours (2 business days).
- The supervisor should complete the reporting forms. However, due
to time constraints on reporting motor vehicle accidents, the DA 2041
can be submitted by the employee or the supervisor.
- Submit forms electronically via the Incident
and Accident
Reporting web page.
- University Police do not need to be contacted unless the
accident involves Emergency Medical Service response. For vehicle
accidents, contact University Police if the accident involves an
LSUHSC-owned vehicle, occurred on LSUHSC grounds, or involved an injury
or death.
- Report any incident or accident involving recombinant DNA to the
Biological Safety Officer immediately. If necessary, this will allow
LSUHSC to report the incident or accident to the National Institutes of
Health within their prescribed timeline.
- If an accident involves serious injury, death, or significant
property damage, the supervisor shall notify senior leadership.
Electronic Submission of Forms
The following steps describe how to access the Environmental Health
and Safety (EHS) web site so that you can submit the appropriate
incident or accident report electronically.
Access the EHS website by the following link path from the Health
Sciences Center home page www.lsuhsc.edu.
Select MyLSUHSC
Select Facilities
Select Environmental
Health and
Safety
On the Incident and Accident Reporting page, click on the
desired
form.
- DA 2000 for reporting an employee incident or
accident.
- DA 3000 for a student, visitor or contractor
incident or accident.
- DA 2041 for an automobile accident that occurs
while drivong on state business. (Remember, DA-2041 forms MUST be submitted within 48 business hours ( 2 business days) of the accident.
Fill out forms completely, including the electronic signature.
Once finished, click on “Save & E-mail” icon at bottom of form.
Then, you will be asked to save a copy of this file.
Next, your Adobe program may ask to continue or allow to send this
e-mail. Select yes and an email will be generated.
Select "Send" and your email will be sent to the proper individuals.
Other Forms
For employees that incur medical expenses as a result of a work-related accident, supervisors shall complete the
DA1973 form and fax (504) 568-8010 or email to
Brandon Nicholas in the Human Resources Department. For more information see
Workers’ Compensation page.
Specific Reporting Requirements
The following steps provide information on reporting and submitting
the incident and accident reports for:
- Employees
- Students
- Visitors or Contractors
- Vehicle Accidents
Employee Reporting
- Seek immediate medical attention if required. Note that
University Police does not need to be contacted unless the accident
involves Emergency Medical Service (EMS) response.
- Report the incident or accident to your supervisor.
- The supervisor will complete and submit the DA 2000 form within
five calendar days.
- If the accident results in medical expenses, the supervisor
completes and submits the Office of Workers’ Compensation DA 1973 form.
For more information see Workers’ Compensation page.
- Please Note: Completion of the DA 2000 is required even if a DA
1973 is also submitted.
Root Cause Analysis
- A basic failure of many accident investigations is that they
identify and correct only the immediate causes, or symptoms of an
accident. “Human error” is often listed as the cause of the accident,
when in fact the underlying cause is often more complex, such as lack
of proper training or lack of standard operating procedures.
- Accordingly, completion of the root cause analysis portion of the
DA 2000 form is critical. Determining the true
root cause and taking
corrective action will help prevent a re-occurrence.
Student Reporting
- Seek immediate medical attention if required.
- If the event occurs in the classroom or lab, the instructor will
complete and submit the DA 3000 form within five calendar days.
- If the event occurs outside the classroom or lab, notify
University Police. University Police will then respond and complete and
submit the DA 3000 form.
- Although a Root Cause Analysis is not required for incidents and
accidents involving students, the responsible party should investigate
and take appropriate action.
Visitor and Contractor Reporting
- The escort or sponsor should assist in obtaining medical
assistance if required.
- Notify University Police. University Police will then respond and
complete and submit the DA 3000 form.
Reporting Vehicle Accidents
- Call the local Police to report the accident and obtain a traffic
accident report when available. If the accident involves an
LSUHSC-owned vehicle, occurred on LSUHSC grounds, or involved an injury
or death, notify University Police at 568-8999 or 568-8270.
- Complete and submit an on-line fillable DA 2041 form within
48 business hours (2 business days).
Alternatively, to expedite submittal if the DA 2041 form has been
completed by hand, it may be scanned and emailed to DA2041@lsuhsc.edu
and 6410StateofLouisiana@sedgwickcms.com.
- Include a copy of the local police traffic accident report with
the DA 2041 submission. However, if the local police traffic accident
report is not immediately available, submit the DA 2041 without it and
follow-up later when received. Due to the time constraints on
reporting, the DA 2041 can be submitted by either the employee or the
supervisor.
- To facilitate timely completion of the DA 2041, keep a hardcopy
of the Vehicle Accident Reporting Quick Guide in your
vehicle.
- Completion of the DA 2000 form is not required for vehicle
accidents.
Summary
- Report all incidents and accidents no matter how minor.
Performing
a root cause analysis on a “near miss” can provide valuable information
that could prevent a future accident.
- Use the proper form depending on who was involved in the
incident or accident. For incidents and accidents involving employees,
the reporting forms should be completed by the supervisor.
- Submit the forms electronically via the EHS web site within
five calendar days. The exception is for vehicle accidents; they must
be reported within 48 business hours (2 business days).
- University Police does not need to be contacted unless the
accident involves Emergency Medical Service (EMS) response. For vehicle
accidents, contact University Police if the accident involves an
LSUHSC-owned vehicle, occurred on LSUHSC grounds, or involved an injury
or death.
- See the “Incident and Accident Reporting and Investigation
Policy” for more information.
- For questions or assistance, contact Jim Davis, Safety Officer,
at jdavis3@lsuhsc.edu
or 504-568-4952.
Any Questions?
Environmental Health and Safety
450A South Claiborne Avenue
New Orleans, LA 70112