Incident/Accident Reporting and Investigation Training
- 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.
- Reporting Responsibilities
- Reporting Forms
- Investigating the Incident/Accident
· Accident: an unplanned event that caused personal injury or property damage. Even “minor” injuries (cuts or sprains) are considered accidents.
· Incident: an unplanned, or “near-miss”, event that could have caused personal injury or property damage.
· Serious Illness or Injury: a condition requiring immediate medical assessment or treatment.
· Minor Illness or Injury: a condition that does not require immediate medical assessment or treatment.
What Should Be Reported
- Serious Illnesses or Injuries
- Minor Illnesses or Injuries
• Shall immediately notify their Supervisor/Instructor of any incident/accident.
• Supervisors/PIs and Instructors:
• Ultimately responsible for reporting employee or student incidents/accidents to University Police.
• Complete and submit the necessary reporting forms within 24 hours.
• Note for serious illness or injury, contact 911 for medical attention.
· Shall respond to all reported serious incidents or accidents.
· Shall notify Environmental Health and Safety of all incidents/accidents.
The Incident/Accident Investigation Form (DA 2000 form) - used to report incidents/accidents involving LSUHSC employees. To view form, click
The Employer Report of Injury/Illness (DA 1973-E1) - used when an accident involves an injury that results in employee and/or student medical expenses or workers’ compensation related loss. To view form, click here
Please Note: In addition to the above forms, a DA 2041 form must be filled out for reporting vehicle accidents to ORM within 48 hours of the accident. Click here to view form.
When Should an Incident/Accident Report (DA 2000) be filled out
- 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.
Who Should fill out the DA 2000 Reporting Form?
- 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.
How to fill out an Acceptable DA 2000 form
- 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).
When Should a DA 1973-E1 Employer Report of Injury/Illness Form Be Filled Out?
- To document ALL Student Incidents/Accidents.
- To document Employee Accidents which involves an injury relating in medical expenses or workers’ compensation.
Who Should Fill Out the DA 1973-E1 Form?
- 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.
How to fill out an Adequate DA 1973 form
- 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
Incident/Accident Notification Procedures
1. For an EMPLOYEE:
· Employees must report any incident/accident to their supervisor/principal investigator IMMEDIATELY.
· The Employee’s supervisor or principal investigator must immediately report every incident/accident to University police (568-8999).
· Supervisor’s or Principal Investigators must complete the First page of the Employee Incident/Accident reporting form DA 2000 and forward to EH&S and HRM within 24 hours of the occurrence.
· If an accident or injury results in medical expenses or workers’ compensation related loss, the Supervisor or Principal Investigator must fill out the DA 1973 -E1 form and forward to HRM within 5 days of the occurrence.
· HRM will notify ORM of the potential claim within 10 calendar days of the injury, enter the DA 1973-E1 data into the STARS Reporting System and People Soft, and send a copy of the DA 1973-E1 to EH&S.
2. For a STUDENT:
· Students must report any incident/accident to their instructor IMMEDIATELY.
· The students Instructor must notify University police (568-8999).
· The students Instructor must fill out the DA 1973-E1 form within 5 days and forward to HRM.
· HRM will maintain the DA 1973-E1 on file and submit a copy to EH&S.
· EH&S will complete the DA 3000 form to document student incident/accidents.
3. For a VISITOR, CLIENT or CONTRACTOR:
· Ensure the visitor, client or contractor notifies the University Police immediately (568-8999).
· University police will respond to all incidents/accidents, conduct initial investigation, and notify EH&S.
· EH&S will fill out a DA 3000 form to document any visitor, client or contractor incident/accident at LSUHSC-NO.
Incident/Accident Reporting Summary
- 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
Time Limits for Reporting
- 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
- 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
- Environmental Health & Safety
450A South Claiborne
Sister Stanislaus Memorial Bld.
New Orleans, La 70112
Phone: (504) 568-6585
- Human Resources Management
Labor Relations Section
6th floor (Suite 603)
New Orleans, La 70112
Phone: (504) 568-3916
425 S. Roman St.
New Orleans, La. 70012
Phone: (504) 568-8999