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Accidental Injury Reporting

 

Forms

 

Policy

The University of Tennessee at Chattanooga shall maintain a comprehensive accident and incident reporting program to provide for the safety of the entire University community. This reporting procedure will allow for the reporting of accidental injuries by employees for Worker's Compensation purposes, as well as provide for timely investigation and correction of potentially hazardous situations. In addition to these reporting procedures, the Department of Safety & Risk Management shall provide a means whereby employees and students may report unsafe or potentially hazardous conditions.

 

Procedure

UTC Department of Safety and Risk Management is responsible for:

  1. Ensuring that all accidents/incidents are reported in a timely manner so that any necessary corrective action may be taken.
  2. For incidents involving bodily injury, the University Safety Officer will conduct or cause to be conducted an investigation of the incident with recommendations for the prevention of similar occurrences where applicable.
  3. Investigating all OSHA 300 reportable accidents and maintaining these reports for a period of five years.

UTC Deans, Directors, Department Heads, and Supervisors are responsible for:

  1. Ensuring all employees under their supervision are aware of the correct reporting procedures for employee accidental injuries.
  2. Completing the "UT Supervisor's Report of Employee Accident" in a timely manner and ensuring its proper distribution (Original to UTC Human Resources).

UTC Campus Police are responsible for:

  1. Completing and forwarding UTC Police Incident Reports to the Department of Safety & Risk Management in the event of any student injuries or damages to University property.

UTC Employees are responsible for:

  1. Complying with University Policies and Procedures for the reporting of accidental injuries.
  2. Reporting all accidental injuries to their supervisors in a timely manner.

 

Reporting Procedures

Department of Safety and Risk Management is responsible for:

Report of Unsafe Condition In the event of an unsafe condition, a "Report of Unsafe Condition" form will be filled out and delivered to the Department of Safety and Risk Management.

Department of Human Resources is responsible for:

  • State of Tennessee Accident Report Form In the event of an accidental injury, all University employees are responsible for completing a State of Tennessee Accident Report. The report should then be forwarded to the employee's supervisor for completion, signature and forwarding to the UTC Human Resources Department. This completed form should be received by Human Resources no later than six (6) working days after the accident.
  • Supervisor's Report of Employee Accident In the event of an accidental injury, all University supervisors are responsible for completing a Supervisor's Report of Employee Accident. Upon completion the original of this two-part form should be sent to the Department of Safety and Risk Management with the copy forwarded to the UTC Human Resources. This completed form should be received by the Department of Safety and Risk Management no later than two (2) working days after the accident.
  • UT Report of Occurrence to be completed by the Department of Safety and Risk Management for all serious injuries and/or losses to the University in excess of $2,000.
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