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Jobsite Accident / Incident Report & Investigation Form Instructions

** The treatment of the injured employee takes priority above all else. **

If an employee is injured while at a job site, working in the shop, or in transit the following steps shall be taken:

1. Treatment

    a. MINOR INJURY: If the injury is minor and can be cared for onsite; administer the minor first aid required, with the assistance of coworkers as needed, then fill out the accident report form and turn in a copy to the property owner or Management Company and the original to the office by the end of the day.

    b. NON-TRAUMATIC INJURY: If the injury requires medical attention and is non-traumatic; first have a coworker transport you to a minor medical facility if available or to an emergency room for treatment. Injured employees shall not drive themselves to the treatment facility. The coworker that transports you should begin filling out the accident form and notify the office as soon as practical. Notification of this will be relayed to the property owner or Management Company from our office.

    c. TRAUMATIC INJURY: If the injury is traumatic call 911 and follow their instruction until they arrive on site. Never leave the injured person alone for any reason. Once EMS arrives and your assistance is no longer required, contact the office to report what happened. Next, begin filling out the accident report, gathering witness names, contact information, and a statement of what happened. Assist the property owner or management company in any investigation they are doing and request a copy of their investigation for our records as well.

2. Reporting

    a. ACCIDENT – An incident in which someone is injured

    i. Accident / Incident Report

  • 1. Report needs to be filled out completely and as soon as possible to avoid missing witness’ names or other important information. Be sure to be detail oriented when filling out this report. The information you place on this report could aid in preventing such an occurrence from taking place in the future. All accident / incident reports shall be turned into the office by the end of the day or when practical in extreme emergencies. If questioned, this report will be made available to the owner or property manager upon request. These reports should always be kept in all company vehicles. If you find that these reports are missing from a vehicle, it is your responsibility to request copies from the office and ensure they are placed in the vehicle. Refer to Policy NMS303 Worker’s Compensation Insurance in the Employee Handbook for information regarding information on worker’s compensation.
  • ii. Employee’s Choice or Change of Doctor

  • 1. This form needs to be filled out and signed by the injured party as soon as reasonable. It is required to be sent to the insurance company along with the First Report.
  • iii. First Report of Alleged Occupational Injury or Illness

  • 1. Give this report to the office staff for completion using the information you provide on the Accident/Incident Report. It is required to be filled out and returned to the insurance company within 7 days of the incident.
  • iv. A Drug test may take place as soon as practical after any accident

  • 1. Office staff will handle the process of all drug tests
  • b. CLOSE CALL – An incident in which no one is injured

    i. Complete the Accident / Incident Report

  • 1. During an incident in which no one is injured but a show of a safety hazard or hazardous practice has occurred that could have resulted in an injury it is every employee’s responsibility to report it. Fill out the same report as an accident. Please be detailed in your summary of the incident so that an accident may be prevented from occurring in the future.

3. Review

    a. Accident/Incident Investigation Report

    i. Return Report to front office. The Safety Committee will review the Accident/Incident Report and make any determination based upon the rules and guidelines of the Safety Program

** Anytime you are unsure of what to do, please call the office immediately **