Accident Reporting

Accident Reporting

1. If an employee suffers an on-the-job injury, the employee’s supervisor must be notified immediately so that the supervisor can assess the nature and extent of the injury. All medical care provided to the employee will be selected and approved by the University of North Carolina at Pembroke. If the injury is serious and requires immediate medical attention, the supervisor will call 911 to facilitate stabilization and transport of the injured employee to a hospital or other appropriate medical care facility. Less serious injuries that still require medical attention will be referred by Human Resources (HR) via the supervisor to an approved medical provider. First aid cases may be directed to an approved physician’s office or treated in the department, depending on the nature and extent of injury.

2. As soon as it is feasible at the time of the incident, the employee should complete the North Carolina  Employee Incident Report and their supervisor should complete a copy of North Carolina Supervisor Incident Investigation Report. These forms are available in each respective department, on the Human Resources Department website, and the Environmental Health and Safety (EH&S) Office Accident Reporting webpage. These forms should be completed and forwarded as soon as possible to HR and the EH&S Office. If off-campus medical care is required, the supervisor should contact HR for a copy of the Workers Compensation Authorization/ Physicians Report/Pharmacy Guide and provide this form to the injured employee.  The employee will then take it to the attending physician’s office where it will be completed by the medical provider. This form will be used to verify the initial treatment authorization for medical services.

3. As soon as possible after an incident, the employee’s supervisor should contact the EH&S Office so that a thorough investigation of the events surrounding the incident can take place. A root cause analysis will be conducted to identify the cause of the incident.  Once a cause has been determined, remedial action (policy changes, work orders, re-training, etc.) will be implemented to insure that the hazards are mitigated and that a repeat incident will not occur.

4. After medical treatment has been provided to the employee, the injured employee and/or his/her representative should return the Workers Compensation Authorization/ Physicians Report/Pharmacy Guide to HR via the supervisor. Approved physician offices will be aware of the necessity to complete the paperwork in a timely manner and will be prepared to do so. If an employee is returned to work with restrictions, alternate duty work will be made available to the employee when possible. Priority for alternate duty work will be firstly, to return the employee to the employing department, secondly to the employing division, and thirdly to return the employee to work in another University division.

5. If the employee is unable to return to work, the HR Department will consider the case for referral to a third party administrator for rehabilitative case management. Ongoing medical care for the injured employee will be coordinated by HR and the designated Case Manager until the employee is released to return to work.

Workers’ Compensation Forms:

Select a link below to download:

Instruction to Injured Employees
Vehicle Accident Report
NC Employee Incident Report
NC Supervisor Incident Investigation Report
NC Witness Statement Form

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