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Stanford University Serious Injury/Illness Reporting Procedures I. Regulatory Background Per Cal/OSHA regulation, 8 CCR 342 Reporting Work-Connected Facilities and Serious Injuries, employers shall report any work-related serious injury or illness, or death to Cal/OSHA as soon as practically possible, but not longer than 8 hours after the incident. Cal/OSHA defines an injury or illness as “serious” if it: • Requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation; or • An employee suffers a loss of any member of the body; or • An employee suffers any serious degree of permanent disfigurement II. Stanford Reporting Procedure In the event of serious injury, illness or death: 1) Call the EH&S Emergency Hotline at 725-9999 immediately. (During non-business hours, this number will reach a Univers ity op erator who will co llect inciden t in formation a nd contac t EH&S.) 2) The OH&S Program will take th e f acts abo ut the incid ent and th e status of the inju red employee(s) from the supervisor. 3) The OH&S Program will report the incident to Cal/OSHA district office. 4) Supervisor completes the requisite forms (refer to Appendix A or contact Risk Management at 723-7400) 5) Supervisor follows up on incident and documents corrective actions (using the SU-17 Incident Investigation Report). EH&S will review all SU-17 forms and contact supervisors as needed for follow up. The goal of incident investigations is to prevent incidents from recurring, not to assign culpability. Who Calls Cal/OSHA? • EH&S is the designated University authority to report serious incidents to Cal/OSHA. The EH&S emergency reporting number (5-9999) is monitored 24 hours a day. • Supervisors and co-workers are NOT to contact Cal/OSHA directly to report serious incidents. What are the Time Limits for Reporting? • EH&S shall report all serious incidents, injuries, and illnesses to the nearest District Office of Cal/OSHA as soon as practically possible, but not longer than 8 hours after the incident. • Failure to immediately report serious incidents and injuries to EH&S can result in Cal/OSHA citations and fines (note: regulatory violations are to be paid by the operating unit responsible for the citations). Additional information on incident reporting at Stanford University is available from: • Appendix A – Stanford University Work-Related Incident/Injury/Illness Reporting Forms • EH&S (723-0448 or http://iipp.stanford.edu) • Office of Risk Management (723-7400 or http://web.stanford.edu/dept/Risk-Management/), or • Stanford University Administrative Guide: 25.2 – Emergency/Accident Procedures 25.6 – Accident and Incident Reporting IH Report # 00-038c 02/15/11 Appendix A - Stanford University Work-Related Incident/Injury/Illness Report Forms Supervisors are responsible for re porting all work-related incidents, injuries, and illnesses to the Office of Risk Manag ement, by completing the necess ary forms. Forms can be obtained online at http://web.stanford.edu/dept/Risk-Management/) or by calling Risk Management at 723-7400. Table 1. Incident/Injury/Exposure Report Forms Form When to use SU-17 - Incident Investigation Report State Form DWC-1 (Workers compensation) SU-16 – Workers’ Compensation Lost Workdays Report Cal/OSHA 5020Employer’s Report of Occupational Injury or Illness Any incident involving a Stanford University employee, student, visitor, and/or contractor (note: use the SU-17B for non-University employees). Provide to employees when they visit a doctor due to a work-related injury/illness. Instructions Submit to Risk Management within 24 hours Complete and provide to employee within 24 hours of incident or report of incident Complete for employees when one or more workdays are lost Submit to Risk Management upon return to work Complete for employees when treatment is required by a physician in a medical facility Submit to Risk Management as soon as possible, but within 5 days IH Report # 00-038c 02/15/11