Procedures for Reporting Employee Incidents
- Replaces: Supersedes all previous materials on the same topic
- Reviewed: Annually
- Section Revised: Separated from Incident Management and Moved to Google Sites 1/1/2022, 1/1/2022, 2/1/2022
- Contact: Head of Human Resources
All incidents must be reported. No incident is too small or too insignificant to report.
Reporting ALL Employee Incidents
Immediately Upon Learning of an Incident
As soon as you learn of a work-related incident, you or a designee must follow these steps:
Ensure that appropriate first aid or emergency care is provided.
Consult the head of Human Resources, the District Director of Health, or their designee to determine whether the employee is required to report to St. Elizabeth Business Health for a post-incident drug and/or alcohol screen.
When the employee is required to report for a post-incident drug and/or alcohol screen, then instruct her/him to report immediately and inform them that they will be off work pending results of the screen(s). (See Appendix B for details about St. Elizabeth Business Health.)
When an employee is involved in a vehicle crash, obtain a police report from the employee and email it as a .PDF to hr@nkyhealth.org.
When an employee is involved in a vehicle crash, is exposed to a bloodborne pathogen and/or is injured or becomes ill, ensure they immediately complete and submit the Employee Incident Report - Employee Statement and Certification form, found on the Incident Reporting Forms page of the Workplace Safety Site. (When the injury/illness renders an employee unable to complete the form please contact the head of Human Resources for further instruction.)
Upon receipt of the completed Employee Incident Report - Employee Statement and Certification form, complete and submit Employee Incident Report - Supervisor Statement and Certification form.
When an employee is involved in a vehicle crash, is exposed to a bloodborne pathogen and/or is injured or becomes ill, use the information on the completed Employee Incident Report - Employee Statement and Certification form to complete the required fields in Form IA-1 Workers Compensation First Report of Injury or Illness using the Workers Compensation workflow in AdobeSign and send it to the employee for signature.
Under no circumstances is the employee to complete this form theirself.
(See Workers Compensation Plan Details for information about the Workers’ Compensation Plan. See Instructions for Completing form IA-1 for information about completing the workers’ compensation form.)
Print the completed and signed Form IA-1 Workers Compensation First Report of Injury or Illness from AdobeSign and fax it to the workers’ compensation carrier within the deadlines noted in the sections below.
When an employee is likely to need additional medical attention, direct them to coordinate care through NKY Health’s workers’ compensation carrier prior to seeking treatment or is likely to need a prescription, obtain a Workers’ Compensation Rx Benefits form.
When the employee does not have their white plastic BHN Workers Compensation card obtained during orientation, give them another card.
When not an emergency, remind the employee that use of out-of-network providers may result in non-payment of claims.
When an employee is exposed to a bloodborne pathogen, follow the Procedures for Reporting and Managing Exposure Incident in the Bloodborne Pathogens section of this manual. Be sure to record this as a privacy concern case on the OSHA 300/300A forms.
Within 24 Hours of the Incident
When the incident involves and emergency, print the completed Form IA-1 Workers Compensation First Report of Injury or Illness from AdobeSign and fax it to the Workers’ Compensation carrier within 24 hours of the incident.
Within 48 Hours of the Incident
When the incident is NOT an emergency, print the completed Form IA-1 Workers Compensation First Report of Injury or Illness from AdobeSign and fax it to the Workers’ Compensation carrier within 48 hours of the incident.
The Workers' Compensation carrier must receive this form before they will authorize care for the employee.
Within 7 Calendar Days
When an incident is recordable, contact the site manager to record it on the OSHA – 300 Log within seven (7) calendar days of the day you receive information that confirms it is recordable.
(Refer to Guidelines for OSHA 300 Form Recordable Cases for more information about what is or is not recordable according to OSHA. Refer to Instructions for Completing OSHA 300/300A Form for instructions on completing the form and for a sample of a completed form.)
Ongoing
Email the head of Human Resources as you learn any details related to the incident (days missed from work, medical attention sought, etc.)
Reporting Employee Incidents Involving Death, Hospitalization, Amputations and/or Loss of an Eye
In addition to the steps outlined in the "Reporting ALL Employee Incidents" section above:
When any employee dies or if three (3) or more employees are hospitalized you must report this to both OSHA and KYOSH within eight (8) hours of finding out about the incident
When an incident involves results in an in-patient hospitalization, amputation, and/or loss of an eye you must report this to both OSHA and KYOSH within 24 hours of finding out about the incident.
You may make the reports to OSHA by telephone or in person to the Area Office of the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor nearest to the site of the incident. You may also use the OSHA toll-free central telephone number, 1-800-321-OSHA (1-800-321-6742).
You may make the report to KYOSH by telephone at (502) 564-3070. If you become aware of the incident during non-business hours and no one is available at this number, then call again the next business day and provide details about the date and time and who took the report at OSHA.
Routing Forms
Route completed forms as follows:
FORM USE ROUTE TO
Employee Incident Report Employee Incident Report - Employee Statement and Certification Form Automatically Routed
Employee Incident Report - Manager Statement and Certification Form Automatically Routed
First Report of Injury Employee Incident Print and Fax to Carrier; Automatically routed internally
Visitor Incident Report Visitor Incident Report - Employee Statement and Certification Form Automatically Routed
Visitor Incident Report - Manager Statement and Certification Form Automatically Routed
Source Individual Consent BBP exposure Employee Health Nurse
Physician Treatment BBP exposure Employee Health Nurse
MedWatch Device failures/Drug reactions Employee Health Nurse
VAERS Adverse event after immunization Employee Health Nurse