Policy: Accident & Injury Reporting Category: Operations. Authorized by: Joan Arruda, CEO

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1 Category: Operations Authorized by: Pages: 11 Date effective: Dec. 15, 2010 To be revised: Dec. 15, 2013 Revised: May 9, 2011 Joan Arruda, CEO POLICY This Policy and Procedure is intended to bring consistency throughout all Family Day s operations in complying with the responsibility to report occupational injuries, illnesses and accidents. Managers, Supervisors, staff, students and volunteers of Family Day are equally responsible to report the following: any accident resulting in a workplace injury (no matter how slight) any near-miss incident that could cause a disabling injury or loss to property or equipment any accident resulting in a discharge or spill of a contaminant or pollutant into the environment. In all cases, accident and/or injury reporting shall comply with the requirements of Ontario Occupational Health and Safety Act (OHSA). Purpose Family Day Care Services and its staff is required to comply with statutory reporting regulations related to the appropriate reporting of occupational injuries, illnesses and accidents within prescribed time limits. Scope This Policy and its Procedures apply to all Managers, Supervisors, employees, volunteers, students and visitors. Definitions: Adverse Effect One or more of: (a) an impairment of the quality of the natural environment for any use that can be made of it (b) an injury or damage to property or to plant or animal life (c) harm or material discomfort to any person (d) an adverse effect on the health of any person (e) impairment of the safety of any person (f) rendering any property or plant or animal life unfit for human use (g) loss of enjoyment of normal use of property (h) interference with the normal conduct of business. Contaminant Any solid, liquid, gas, odour, heat, sound, vibration, radiation or combination of any of these resulting directly or indirectly from human activities that causes or may cause an adverse effect. Contaminants also include a pollutant and any substance defined as: Family Day Care Services Page 1 of 11

2 (a) a controlled product within the meaning of the Hazardous Products Act (Canada) (b) a substance designated as a hazardous substance by regulation (c) a biological, chemical or physical agent that, by reason of its properties, is hazardous to the health or safety of persons exposed to it. Critical Injury An injury of a serious nature that: (a) places life in jeopardy (b) produces unconsciousness (c) results in substantial loss of blood (d) involves the fracture of a leg or arm but not a finger or toe (e) involves the amputation of a leg, arm, hand or foot but not a finger or toe (f) consists of burns to a major portion of the body (g) causes the loss of sight in an eye. Occupational Illness A condition that results from exposure to a physical, chemical or biological agent in the workplace to the extent that the worker s normal physiological mechanisms are affected and the health of the worker is impaired. Pollutant Any solid, liquid, gas, odour or combination of these that causes or may cause an adverse effect. Responsibility Supervisors/Managers Each Manager/Supervisor is responsible for: ensuring, as a priority, that employees receive appropriate medical treatment when injured investigating an accident or workplace injury for the purpose of implementing corrective action to minimize any opportunity for a recurrence of the accident or injury ensuring employees or persons under their control are made aware of, know and adhere to the reporting requirements outlined in this policy ensuring that Accident Investigation reports are properly prepared and issued in a timely manner to the appropriate authorities consistent with the reporting requirements specified in Ontario statutes ensuring all employees are familiar with this policy and related forms. Employees Every employee of Family Day is responsible for: immediately reporting any workplace injury, accident or illness to his or her immediate supervisor immediately reporting any near-miss events and/or unsafe work situations, equipment or protective device to his or her immediate supervisor. Family Day Care Services Page 2 of 11

3 Procedures All Accidents and Injuries In the case of an accident or injury at Family Day, the injured employee shall be provided with immediate medical attention as required. The Manager/Supervisor must investigate the severity of the incident. All critical injuries (see Definitions) and property damage exceeding five hundred dollars ($500) shall be reported to the Chief Executive Officer (CEO) immediately by telephone. If the CEO is unavailable, another member of the Senior Management team must be spoken to personally on the telephone. If the individual is required to be absent from work the Manager/Supervisor must notify Human Resources/Payroll within 24 hours. HR will forward the appropriate benefit claim forms to the injured employee. Only a person holding a current and valid First Aid Certificate is qualified to administer First Aid to an injured employee. Appropriate steps shall be taken to address any continuing risks to other participants health and safety. Completing the Accident Investigation Form The Manager/Supervisor must investigate the incident and complete an Accident Investigation Form (APPENDIX A.) The Manager/Supervisor must complete the Supervisor and Action Plan and Corrective Measures sections of the Accident Investigation Form. If an employee was injured, he or she must fill out the Employee Section of the Accident Investigation Form. If an employee was a witness to an accident, he or she must provide a written witness statement on the Accident Investigation Form. The injured employee must obtain the appropriate medical certificate from a doctor if he or she is to be absent from work. All Accident Investigation Forms and documents related to the accident (e.g. - medical notes) must be sent to Human Resources immediately to be kept in the employee s file. Any personal medical information will be in a sealed and confidential envelope accessed only by Human Resources. Corrective Measures All critical injuries and/or severe property damage exceeding $500 shall be reviewed by the Joint Health and Safety Committee. The JHS Committee will recommend corrective measures to Senior Management in writing, in which Senior Management will respond, in writing, within twenty-one (21) days to the proposed recommendations. Recommendations/corrective measures will be implemented based on the decision of Senior Management and the JHS Committee. Family Day Care Services Page 3 of 11

4 The Manager/Supervisor shall complete an Accident Follow-Up Investigation Form (APPENDIX B) with a JHS Representative. The Accident Follow-Up Investigation Form will be reviewed by the JHSC to ensure that corrective measures are implemented. Deaths or Critical Injuries Family Day Managers, Supervisors, Certified Health & Safety Representatives and Designates are responsible for determining whether an incident is deemed to be a critical injury. In the event that an incident results in a death or critical injury, a call to 911 shall be made immediately. All critical injuries and deaths shall be reported to the CEO immediately by telephone. If the CEO is unavailable, another member of the Senior Management team must be spoken to personally on the telephone. In the case of all deaths and critical injuries, the Manager/Supervisor shall immediately contact the Ministry of Labour Safety Inspector by telephone. The Ministry of Labour Inspector shall also be notified, in writing, within forty-eight (48) hours after the occurrence, giving the circumstances of the occurrence and any information prescribed by the Occupational Health and Safety Act. Ministry of Labour Office Contact Information (Deaths & Critical injuries only) Central Region Office Telephone Number Fax Number Address 1201 Wilson Avenue Building E, 2nd Floor Downsview, ON M3M 1J8 The Manager, Supervisor or Designate shall also immediately contact and report the critical injury or death by direct means to: a member of the Joint Health and Safety Committee the Union If the Ministry of Labour Inspector requests an inspection, a JHSC member should accompany the Ministry of Labour inspector during the inspection of workplace. Accident, Explosion or Fire Resulting in Disablement and/or Requiring Medical Attention In the event of an accident, explosion or fire where a worker is disabled or requires medical attention, the Manager, Supervisor or Designate shall contact the: Ministry of Labour Safety Inspector with details of the accident, in writing, within four (4) days of the occurrence. Written details of the accident can be found on the completed Accident Investigation Form. Health and Safety Representative or the Joint Health and Safety Committee, in writing, within four (4) days of the occurrence. Union, within four (4) days of the occurrence, in writing, containing details of the accident found on the Accident Investigation form. Family Day Care Services Page 4 of 11

5 Occupational Illness In the case that Family Day Care Services is advised that an employee or former employee has an occupational illness (see definitions), a Manager, Supervisor or Designate shall notify: the Ministry of Labour Safety Inspector, in writing, within four (4) days of first learning of the occupational illness the Health and Safety Representative or a member of the Joint Health and Safety Committee, in writing, within four (4) days of first learning of the occupational illness Union, in writing, within four (4) days of first learning of the occupational illness. See: APPENDIX A: Accident Investigation Form APPENDIX B: Accident Follow-Up Investigation Form APPENDIX C: Accident & Injury Reporting Process Map Sources for Definitions: Environmental Protection Act (Ontario) and Regulations Occupational Health and Safety Act (Ontario) and Regulations Ontario Water Resources Act Family Day Care Services Page 5 of 11

6 APPENDIX A: Accident Investigation Form Employee Section Name: Centre/Program: Employee #: Job title: Job being performed at time of the incident: Date hired in this position: Supervisor s Name: (year/month/day) Were there equipment or tools involved in the incident? Employee Statement Describe the incident, including what the employee and others were doing and what they were tying to do. Identify anything unusual about the situation. Employee Name (print): Signature: Identify the equipment/material involved (size, weight, damage description) Were there witnesses? If yes, have them complete statements in the area below. Witness #1 Statement: Describe the incident, including what the Employee and others were doing and what they were trying to do. Identify anything unusual about the situation. Witness #2 Statement: Describe the incident, including what the Employee and others were doing and what they were trying to do. Identify anything unusual about the situation. Employee s Signature: Employee s Signature: Family Day Care Services Page 6 of 11

7 Name & Signature of individual if they are not staff: Name & Signature of individual if they are not staff: Action Plan and Corrective Measures (to be filled out by the Supervisor) Could this situation have been prevented: Yes No Why was it done that way? Why did these conditions exist? How will we control the above? How will we correct the condition(s)? Estimated completion date: Estimated completion date: Who will assume responsibility for control? Be specific: Who will assume responsibility for corrections? Be specific: Signature of person completing Action Plan and Corrective Measures section: Supervisor to forward the Employee Section and the Supervisor/Action Plan and Corrective Measures Sections to the Human Resources Director within 24 hours of the incident. Program Manager Proper safety or work procedure not followed, counselling required. Proper safety or work procedure followed, procedure inadequate. Procedure evaluated and revision required. Reviewed and Approved by: Program Manager: JH&S Co-Chairperson: Director, Human Resources: Director, Development & Programs: Additional Comments (required if disapproved): Date control completed: Follow-up/Closure Date corrections completed: Verification of Completion Director, Human Resources Signature: Joint Health & Safety Co-Chair Signature: Family Day Care Services Page 7 of 11

8 Supervisor Section Accident/Incident Environmental Property Damage Near Miss Please Check One: First Aid Medical Aid Lost Time Fatal If first-aid treatment was administered, was the treatment provided recorded in the communication book? Yes No Did the employee receive medical treatment from a doctor on the day of injury? Yes No If yes, please fill out below: Name of Doctor: Phone Number: Name of Hospital or Clinic: Address: Describe the injury (parts of body and nature) Date of incident: Time of incident: a.m. p.m. Department/Centre: Shift: Date reported: Time reported: a.m. p.m. Reported to: Severity of Incident: Property damage: None Minor (<$50) Moderate (<$500) Major (>$500) Modified Duties Offered: Yes No Date offered: If yes, describe the modified duties offered: Injury Type: Immediate cause of personal injury: contusion twist cut rash burn inhalation crush shock strain other: please explain: over exertion/strain struck by/against caught in/between fall contact with/by exposure to slip other: please explain: Last Worked Time: a.m. p.m. Date Returned: Time: a.m. p.m. Supervisor s description of incident based upon investigation (who, what, where, how, why): Was Personal Protective Equipment appropriately utilized? Were safety guidelines followed? To your knowledge has the worker had a previous similar injury/disease? No Yes If yes, provide details: Family Day Care Services Page 8 of 11

9 Do you have any reason to believe that the injury/disease is not work-related: No Yes If yes, please explain: Injury Loss Severity Potential: Major Serious Minor Supervisor s Signature: Probable Recurrence Rate: Frequent Occasional Rare Safety Section Unsafe Action YES NO Lack of skill or knowledge Unsafe act of other Physical limitation or mental attitude Failure to use proper tools or equipment Failure to wear PPE Unaware of hazards Short cut to save time or effort Unsafe material handling Other: What was done unsafely? Unsafe Condition YES NO Lack of job safe practice (footwear) Improper material storage Congestion lack of space Improper and/or worn tools and equipment Unsafe design and/or construction Unsafe condition of machine Improper guarding Improper job procedure Unsafe floors, ramps, stairways Improper lighting Other: What unsafe condition existed? FOR HR DEPARTMENT USE: Lost Time Accident: Family Day Sick Day/Self Insurance Claim: Sun Life Claim: Completed report should be filed with HR and Sun Life on the day of the accident. Copy to be retained in the Employee s HR File. Family Day Care Services Page 9 of 11

10 APPENDIX B: Accident Follow-Up Investigation Form To be filled out by the Supervisor and the Health & Safety Representative for all accidents requiring lost time and/or corrective measures Investigation Details Supervisor s Name: Centre/Program: Health & Safety Representative s Name: Date of Investigation: ACCIDENT INFORMATION Injured Employee s Name: Job Title: Date of Original Accident: CORRECTIVE MEASURES What corrective action was proposed at the time of the accident? Were the proposed corrective measures implemented without delay? Yes No If yes, please fill out below: Date Implemented: / / (mm,dd,yy) If no, please state the reason why corrective measures were not implemented below: Please describe the corrective measures below: Expected implementation date: / / (mm,dd,yy) If applicable, has additional training been given to all employees involved in the incident on safe work procedures and hazard identification? Yes No If yes, please describe training: If tools or machinery (e.g. kitchen tools) were involved in the original incident, was regular maintenance of the tool(s) and/or machine(s) completed? Please describe (who, what, when, how.) Family Day Care Services Page 10 of 11

11 Have there been any similar accidents since the corrective measures were implemented? Yes No If yes, what other corrective action must be taken? Employee Wellness What is the current status of the employee who was involved in the accident? If the employee is still off of work, has the Supervisor called to find out how the employee is doing? Fully recovered and back at work Yes No At work and on modified duties Still off of work Other (please explain): If yes: date employee was called: / / (mm,dd,yy) What is the employee s current status? Who will take responsibility for the next follow-up? Date of next follow-up: Has Human Resources been notified of the employee s current status? Yes No (If no, please notify Human Resources immediately) Date Human Resources was notified: / / (mm,dd,yy) If the employee is still off of work, what action plan has been developed to facilitate the employee s safe return to work? Please describe. Report Completed by: Supervisor s Signature: Health & Safety Representative s Signature: Completed report should be filed in the Employee s Human Resources File. Please send a copy of this form to Human Resources. Family Day Care Services Page 11 of 11

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