Incident Report

In accordance with SPPM 2.24.1, University faculty, staff, volunteers, and students are to promptly report all accidental injuries and work-related illnesses to immediate supervisors for evaluation and possible investigation.

Supervisors of University departments coordinating the use of University facilities or University-sponsored activities are responsible for reporting all accidental injuries incurred by individuals who are not employed by WSU.

Report a workplace injury or illness

Report all workplace injuries to your Supervisor immediately and seek medical treatment if needed. Timing is everything: WSU policy requires that all (major and minor) injuries be reported within twenty-four hours. Prompt reporting eliminates delays in benefits to individuals.  For injuries that occur over the weekend or after regular business hours (Monday through Friday, 8 am to 5 pm), reports should be submitted the next regular business day after the accident.  Major incidents resulting in serious injury (e.g. fracture or amputation), in patient hospitalization or death are to be reported immediately. (See SPPM 2.24.1

Reportable incidents consist of:

Injury: Any wound or damage to the body resulting from an instantaneous event. Examples include; cuts, bruises, contusions, chipped teeth, amputations, insect bites, electrocutions, burns sprains, and sprain injuries to muscles, joints, and connective tissues resulting from a slip, trip, or fall.

Illness: A condition resulting from chronic exposure to the work and/or academic environment.  Examples include: musculoskeletal disorders (e.g. tendinitis, carpal tunnel syndrome), skin disorders, respiratory conditions, and noise-induced hearing loss

Supervisor completes:

  1. Online Incident Report

AND IF

  • The employee receives medical treatment.
  • The employee is unable to work the next full or subsequent shift(s) as a result of the injury or illness
  • Events and conditions involving a near miss or minor accident indicate that most likely injury or illness would have been serious.

2. Supervisor’s Accident Investigation Report

Employee/Witness completes:

  1. Witness/Injured Person Statement (optional)
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