Safety Policy Manual Policy No. 101

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Bernice Gardner
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1 Policy: Employee Occupational Injury/Illness Reporting System Page 1 of 6 APPLICATION NYU Langone Medical Center PURPOSE To collect and analyze data on employee injuries and illnesses in order to identify opportunities for prevention. To fulfill the legal reporting and record keeping responsibilities required by the New York State Workers Compensation law and the Occupational Safety and Health Administration (OSHA). 1.0 Policy POLICY AND GENERAL INFORMATION 1.1 All employees are required to report any job-related injury or illness, including a needlestick, immediately. HJD employees may report orthopedic injuries to the HJD Orthopedic Immediate Care Center (I-Care). Employees must report all other injury or illness to Employee Health Service (EHS) or the Emergency Department (ED) when EHS is closed. 1.2 An employee may elect not to receive treatment. However, he or she still must report the injury or illness to EHS, the ED, or the I-Care. 2.0 Injury/illness report 2.1 Employees must document all job-related injuries and illnesses by completing an Employee Occupational Injury/Illness Report (EOIIR). There are campusspecific EOIIRs (see Appendices A and B). Employees who are seen at EHS or in the ED are given the form at those locations. Employees who work on the HJD campus and will be seen at the I-Care obtain forms from the Department of Loss Prevention, room Procedures for completing and distributing the EOIIR (main campus): The employee completes and signs Part I of the EOIIR while at EHS or the ED.

2 Policy: Employee Occupational Injury/Illness Reporting System Page 2 of After examining the employee, the medical professional completes and signs Part II of the EOIIR Personnel in EHS and the ED input data from Parts I and II into the Occupational Health Management (OHM) database. They send the white and pink copies of the EOIIR to Environmental Health and Safety. The yellow copy is retained by or sent to EHS to become a permanent part of the employee s health record Environmental Health and Safety sends the pink copy of the EOIIR to the employee s department The employee s immediate supervisor completes Part III of the EOIIR and returns it to Environmental Health and Safety within three (3) days of the date of receipt. Completion of this section requires that the supervisor conduct a thorough accident investigation. The supervisor must also indicate, by checking the appropriate box, whether the employee lost any time as a result of the injury or illness. Lost time is defined as those days (including weekends) when the employee was unable to work because of an occupational injury or illness. Lost time does not include time lost during the day the injury or illness occurred Environmental Health and Safety determines whether the injury or illness is recordable by OSHA criteria, completes Part IV of the EOIIR, and enters information in the OHM database. 2.3 Procedures for completing and distributing the EOIIR (HJD campus): The employee obtains an EOIIR at EHS, the ED or from the Loss Prevention Department if being seen at the I-Care The employee completes and signs Part I of the EOIIR After examining the employee, the medical professional completes and signs Part II of the EOIIR Personnel in EHS, the ED and the I-Care input data from Parts I and II into the Occupational Health Management (OHM) database. One copy is maintained in or sent to EHS to become part of the employee s record. The remaining copies from EHS or the ED are sent to Environmental Health and Safety who forwards them to HJD Loss Prevention for follow-

3 Policy: Employee Occupational Injury/Illness Reporting System Page 3 of 6 up. The I-Care gives the forms to HJD Loss Prevention for distribution and follow-up HJD Loss Preventions sends a copy of the form to the employee s supervisor for follow-up The employee s immediate supervisor completes Part III of the EOIIR and returns it to HJD Loss Prevention within three (3) days of the date of receipt. Completion of this section requires that the supervisor conduct a thorough accident investigation. The supervisor must also indicate, by checking the appropriate box, whether the employee lost any time as a result of the injury or illness. Lost time is defined as those days (including weekends) when the employee was unable to work because of an occupational injury or illness. Lost time does not include time lost during the day the injury or illness occurred The employee s supervisor retains the Pink copy of the EOIIR and returns the remaining copies to Loss Prevention who will distribute as follows: White: EHS Blue: HJD Human Resources Gold: HJD Loss Prevention HJD Human Resources determines whether the injury or illness is recordable by OSHA criteria, completes Part IV of the EOIIR, and enters information in the OHM database 3.0 Injury/illness investigation 3.1 Environmental Health and Safety (main campus) and HJD Loss Prevention (HJD campus) review all EOIIRs and investigate all major accidents/incidents. 3.2 The investigation addresses the facts, basic causes, and extenuating circumstances involved in the accident/incident. 3.3 A report of the investigation is kept on file in Environmental Health and Safety (main campus) or HJD Loss Prevention (HJD campus). If the report includes recommendations, the investigator follows-up with the appropriate department.

4 Policy: Employee Occupational Injury/Illness Reporting System Page 4 of OSHA log and postings 4.1 Main campus: Environmental Health and Safety maintains the OSHA 300 log in the OHM system and coordinates all OSHA posting requirements. 4.2 HJD campus: HJD Human Resources maintains the OSHA 300 log in the OHM system and coordinates all OSHA posting requirements. 4.3 The OSHA 300A Summary of Work-Related Injuries and Illnesses for the year is posted from February 1 st through April 30 th each year. 5.0 Annual evaluation 5.1 Environmental Health and Safety (main campus) and Human Resources (HJD campus) complete an annual report, evaluating occupational injury/illness data. 5.2 The annual evaluation is distributed to key administrators and is discussed at the HJD Environment of Care Subcommittee (HJD campus) and the Environment of Care Committee. Appendix A Employee Occupational Injury/Illness Report (Form # 381 NYUMC 3/09) Appendix B Employee Occupational Injury/Illness Report (HJD campus) Issue date 11/11 Replaces 9/09 Reviewed by G. Griffin, Environmental Health and Safety M. Phillips, Employee Health Services T. Fascianella, HJD Loss Prevention A. Bender, HJD Human Resources NYUHC Environment of Care Committee

5 Safety Policy 101, Appendix A Employee Occupational Injury/Illness Report (Form # 381 NYUMC 3/09)

6 Safety Policy 101, Appendix B Employee Occupational Injury/Illness Report (HJD campus)

MODEL POLICY TO COMPLY WITH NEW OSHA INJURY REPORTING REQUIREMENTS

MODEL POLICY TO COMPLY WITH NEW OSHA INJURY REPORTING REQUIREMENTS XYZ COMPANY INCIDENT & INJURY REPORTING POLICY 1.0 Purpose It is the policy of XYZ Company (Company) that all incidents that result in