ACCIDENT REPORTING COMPANY

POLICY SAMPLE TEMPLATE

EMPLOYEE ACCIDENT / INJURY REPORTING POLICY

ORGANIZATION NAME

00/00/0000

Address

Contact Phone

Web Address

Email Address

VERSION 0.0.0

PREPARED BY	TITLE	DATE
APPROVED BY	TITLE	DATE

Table of Contents

1.	PURPOSE	3

2.	SCOPE	3

3.	POLICY ELEMENTS	3

4.	INSURANCE COVERAGE	3

5.	EMERGENCY ASSISTANCE	3

A.	MINOR INJURIES	3

B.	EMERGENCY MEDICAL ASSISTANCE	3

6.	PROCEDURE FOR REPORTING AN ACCIDENT	3

7.	REPORT FORM PROCESS	3

PURPOSE

Briefly describe the purpose of this document.

SCOPE

Identify the people who are affected by this report policy.

POLICY ELEMENTS

Define the types of accidents or incidents that must be reported.

INSURANCE COVERAGE

Define the organization’s insurance coverage, in particular, what the policy covers for an employee. Mention that there will be repercussions if an employee fails to report an accident.

EMERGENCY ASSISTANCE

MINOR INJURIES

You can find first-aid kits for minor injuries at the following locations:

NOTE: Never touch another person’s blood or other bodily fluids.

Call [NAME OF APPROPRIATE DEPARTMENT] at [PHONE NUMBER] for assistance.

EMERGENCY MEDICAL ASSISTANCE

PROCEDURE FOR REPORTING AN ACCIDENT

You should follow the steps below when an employee is injured: 1. When an employee is a witness to, or is involved in, an incident, they must report it to [PERSONNEL OR AUTHORITIES THAT MUST BE NOTIFIED] by [TYPE OF COMMUNICATION] within [TIME FRAME] of the incident. 2. List the remaining steps in your organization’s reporting process. 3. 4. 5.

REPORT FORM PROCESS

All work-related accidents resulting in an injury, an illness, or a near miss – regardless of the level of severity – shall be documented and investigated by [DEPARTMENT]. Additional investigations may be conducted by other authorities, e.g., the local police, OSHA, etc. 1. The [DEPARTMENT] will make an initial report on all workplace accidents and injuries. 2. Copies of the employee accident reports are kept on file at [LOCATION]. Employees requesting report copies should contact [CONTACT INFORMATION]. 3. List the remaining steps in the report form process. 4. 5.

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