Incident and Accident Reporting
Timely reporting and thorough investigation of incidents or accidents are critical to preventing repeat occurrences. An accident is an unplanned event that causes personal injury or property damage. An incident is an unplanned, or ‘near miss”, event that could have cause personal injury or property damage.
The tab on the left contains the complete "Incident and Accident Reporting and Investigation Policy" , which provides details on responsibilities, reporting and investigation. To facilitate the reporting of incidents or accidents, please use the on-line reporting forms below, which allow you to save the report and email it to the appropriate LSUHSC departments.
- Ensure you have the latest copy of Adobe Reader - Version XI (11.0.10) on your computer. http://get.adobe.com/reader/
- Simply select the correct form below, fill out completely, then select the “SAVE & EMAIL” button at the bottom of form.
- You will then be prompted to save the form to your computer.
- Next, your Adobe program will ask to use your default email application (Microsoft Outlook). Click on continue and a email will automatically be generated for you to then send.
All incidents and accidents must be reported within five calendar days; vehicle accidents must be reported within 48 hours.
Note that in addition to the guidance below, if any accident results in an Emergency Medical Service response, contact University Police. University Police should also be contacted for vehicle accidents if the accident involved an LSUHSC-owned vehicle, occurred on LSUHSC grounds, or involved injury or death.
Except in the cases of visitors, contractors, and students outside of the classroom as described below, University Police does not need to be contacted for minor accidents.
If you have any questions or need technical assistance, contact Jim Davis, Safety Officer, at firstname.lastname@example.org or 504-568-4952.
On-Line Reporting forms:
- For an employee incident or accident, supervisors will complete and submit the DA 2000 form , to include determining the root cause of the incident or accident
- For employees that incur medical expenses as a result of a work-related accident, supervisors will complete and submit the DA 1973 form as well as a DA 2000 form
- For a student incident or accident in the classroom/laboratory, instructors will complete and submit the DA 3000 form
- For a student incident or accident outside of the classroom/laboratory, notify University Police, who will visit the scene and complete and submit the DA 3000 form
- For a incident or accident involving a visitor or contractor, notify University Police. University Police will visit the scene and complete and submit the DA 3000 form
- In the event of an automobile accident while driving on official business, complete the Auto Accident Report DA 2041 form and submit within 48 hours (this includes weekends - - e.g., a vehicle accident that occurs at 4:00 P.M. on Friday must be reported by 4:00 P.M. on Sunday). Alternatively, to expedite submittal if the DA 2041 has been completed by hand, it may be scanned and emailed to DA2041@lsuhsc.edu and 6410StateofLouisiana@sedgwickcms.com. The DA 2000 form is not required for automobile accidents