• To provide the LSUHSC community with the necessary information to ensure timely and accurate reporting of all accidents and incidents.
•  It is the policy of LSUHSC that any University employee, student, visitor or contractor involved in an accident/incident report the occurrence immediately.
• To view the Incident/Accident Reporting and investigation Policy, click here.

• Purpose
•  Definitions
• Reporting Responsibilities
• Reporting Forms
• Investigating the Incident/Accident
• Summary

• Accidents
• Incidents
• Serious Illnesses or Injuries
• Minor Illnesses or Injuries

• Employees and Students:

• University Police:

• To report occupational incidents/accidents involving LSUHSC employees for workers’ compensation and safety purposes.
• For all Employee Incidents/Accidents regardless of whether there was an injury or property damage.

• Supervisors/PIs document Employee incidents/accidents on the first page of the form. Provide copies to Environmental Health and Safety (EH&S) and Human Resource Management (HRM).
• Supervisors/PIs document Employee incidents/accidents sustained during medical procedures at hospitals and clinics, completing Cause Analysis portion. Provide copies to the entire form, including the Root EH&S and HRM.

• Be sure not to leave any fields blank.
• Ask person(s) involved to describe what happened.
• Provide Agency specific information LSU (ex. Baton Rouge, Shreveport, New Orleans, etc.).
• Describe in as much detail as possible how the Incident /Accident occurred. For example, include Date, Time, Employee’s name, Procedure Involved, Name of Device or Equipment used, Injured Body Parts, PPE used, Personnel Present, Contributing Factors, Repeat Occurrences, etc.
• Describe the exact location where the event occurred. (For example, include type of room/location, building name, floor, room number, Department Notations such as “N/A” or “not applicable” are not accepted).

• To document ALL Student Incidents/Accidents.
• To document Employee Accidents which involves an injury relating in medical expenses or workers’ compensation.

•  Instructors document Student incidents/accidents using the entire form. Provide copies to EH&S and HRM. 
• Supervisors/PIs document an Employee accident which involves an injury relating in medical expenses or workers’ compensation on this form and submit to Human Resources Management within 5 days. 
• Even if this form (E1) is completed for an Employee injury, a DA 2000 must still be filled out and forwarded to EH&S and HRM within 24 hour of the occurrence.
• Failure to report in a timely fashion may result in a $500 fine being levied against the University.

• Be sure to fill out all applicable fields.
• Ask person(s) involved to describe what happened.
• Describe in as much detail what work activity was the employee doing when the incident occurred. For example, give weight, size and shape of material or equipment involved; describe what procedures were involved, and indicate if correct procedures were followed.
• Describe in as much detail what caused the incident to happen. For example, give full details the events that resulted in injury or disease, what happened and how, and include the name of any objects or substances involved.
• Describe in detail what part of the body was injured and the name of the injury/illness

• When an Employee Incident/Accident Occurs-
  • Employee notifies supervisor immediately 
  • Supervisor contacts University Police 
  • Supervisor completes DA 2000 and submits copies to EH&S & HRM within 24 hours 
  • Supervisor completes DA 1973 – E1 if accident involves employee medical expenses submitting EH&S & HRM copies within 5 calendar days. 

• When a Student Incident/Accident Occurs-
  • Student notifies instructor immediatel
  • Instructor contacts University Police 
  • Instructor completes DA 1973 – E1 form and submits copies to EH&S within 5 calendar days

• When a Visitor, Client, Contractor Incident/Accident Occurs
  • Ensure Visitor, Client, Contractor notifies University Police immediately 
  • University Police responds and conducts initial investigation, fills out Incident report and notifies EH&S

1.  Employee Accident/Investigation form (DA 2000) form
   • When to Use- Any Incident/Accident involving an Employee regardless of whether there was an injury or property damage.
   • Instructions-Time Limits for Reporting- Completed by the employee's supervisor/PI and submits copies to EH&S & HRM within 24 hours of the occurrence
      
   •  
2. Employer Report of Injury/Illness form (DA 1973-E1) form

•  When to Use-
  • All Student incidents/accidents
  • Employee accidents which involves an injury relating in medical expenses or workers’ compensation.
• Instructions-Time Limits for Reporting- Completed by the Instructor, Supervisor/PI and submits copies to EH&S & HRM within 5 days of the occurrence

Any Questions?

• Environmental Health & Safety 

450A South Claiborne

Sister Stanislaus Memorial Bld.      

Room 206                                        

New Orleans, La 70112                  

Phone: (504) 568-6585

• Human Resources Management 

Labor Relations Section              

RCB

6th floor (Suite 603)                                      

New Orleans, La 70112              

Phone: (504) 568-3916

• University Police