COIDA ACCIDENT REPORTING

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1 COMPENSATION FOR OCCUPATIONAL INJURIES & DISEASE ACT, 1993 Where the accident has caused death, unconsciousness or amputation or where the injured employee is presumed unable to work for a period of at least 14 days, the Provincial Executive Manager of Labour Law must ALSO be notified by telephone or fax, without delay. AN When employers want to report an accident, they must use the following steps: Step 1 Fill in the form Employers must fill in Part A of the W.Cl.2 form. You can get the form at any labour centre or on the website. Step 2 Give the form to the doctor Employers must tear off Part B of the W.Cl.2 form and give it to the doctor or hospital as soon as possible. Step 3 Send the forms to the Compensation Fund Employers must send the form to the Compensation Fund as soon as possible. They do not have to wait for the part the doctor has to fill in. Once employers receive the doctor s part of the form, they can send that too. They can send it to: The Compensation Commissioner PO Box 955 Pretoria Step 4 Pay compensation to the worker Employers must pay compensation to the Worker for the first 3 months after the accident. The Compensation Fund will efund the Employer for this. Step 5 Send follow-up forms Employers must send the First Medical Report (W.Cl.4) as soon as they get it from the doctor. If the Worker stays away from work for a long time, employers must get the Progress Medical Report (W.Cl.5) from the doctor and send it to the Fund every month. When the Worker starts to work again, employers must send the Resumption Report (W.Cl.6), together with the Final Medical Report (W.Cl.5) to the Compensation Fund.If the Worker stays away from work for a long time, employers must get the Progress Medical Report (W.Cl.5) from the doctor and send it to the Fund every month. page 1 of 11 Origination: 2009 { Revision 2013 } tightening up the detail

2 COMPLETING A W.CL.2 Step 1 Complete Part A, page 1 of the form by giving full details; sign and date the form where indicated. Step 2 Detach Part B (an automatic copy of Part A, page 1) by tearing it at the perforation, hand Part B to the Employee and request him/her to hand it to the medical practitioner/chiropractor of the hospital concerned. In serious cases Part B must be forwarded to the medical practitioner/chiropractor or hospital without delay. Step 3 Complete Part A, page 2 of the form giving full details. Step 4 Forward the completed report of an accident together with a certified copy of the Employee s ID and the First Medical Report (W.Cl.4) (if available) to: The Compensation Commissioner PO Box 955 Pretoria 0001 Call Centre: Fax: NB 1. Complete a separate form in respect of each injured employee. 2. This form must not be delayed in expectation of the Employee resuming employment or awaiting medical reports. 3. An employer who fails to report any accident within 7 days to the Compensation Commissioner on this form, shall be guilty of an offence in terms of the Compensation of Occupational Injuries and Diseases Act, 1993 and may be liable for the full amount of compensation payable in respect of such accident. 4. An employer who fails to report accidents that have caused death, unconsciousness or amputation or cases where the injured employee presumed unable to work for a period of at least 14 days to the Provincial Executive Manager of Labour by telephone or fax, shall be guilty of an offence in terms of the Occupational Health and Safety Act, Use the appropriate form for reporting of occupational diseases. (W.Cl.1). 6. If an injured employee should leave your employ, please keep record of the address where he/she can be reached so that monies which might be payable to him/her from the Compensation Fund, can be sent to him/her with your assistance. 7. Minor injuries where no medical attention was required should not be reported, however a record should be kept of such injuries. Please phone HR or as soon as an IOD has taken place. HR will assist where possible. Originals can be sent to HR for further completion or information can be requested to HR. Full copies needs to be sent to HR as soon as possible in order for us to have back up cases where queries are received from the WCC. Any documents that are sent to WCC must be faxed or ed to HR. In cases where a W.Cl.5 Final medical report is not received a progress medical report must be requested from the doctor dealing with the IOD. A W.Cl.6 Resumption report also needs to be completed. page 2 of 11 Origination: 2009 { Revision 2013 }

3 COMPANY - TERMS AND CONDITIONS 1.8 Compensation for IOD Where employees are involved in an accident arising from and during the course of employment, which results in personal injury, the Company shall pay the Employee as per legislation. Thereafter the disability policy may apply provided that the employee is a member of one of the Company s Pension/Provident Funds. COMPANY - TERMS AND CONDITIONS 7.6 Accidents and Injuries All accidents and injuries must be reported immediately. page 3 of 11 Origination: 2009 { Revision 2013 }

4 EXTENT OF INJURY 1. Minor Injury where first aid only is required. FORMS TO BE COMPLETED First Aider or Health and Safety Rep to complete Step 1 - Fill in first aid register (See attached A1). Kept in first aid box. Step 2 - Bring first aid register to the next Health & Safety Committee meeting. Note: Should this I.O.D warrant medical treatment at a later stage please follow steps as per B below. A 2. An injury which results in the Workman having to receive medical attention other than First aid i.e. at a clinic, hospital, or by medical doctor. First Aider or Health and Safety Rep to complete Step 1 - Ensure injured party is taken to Doctor. EMPLOYERS REPORT OF (See Attached A 2) Step 1 - Complete Part A page 1 & 2 Step 2 - Sign and Date form where necessary Step 3 - Detach Part B page 1 (an automatic copy of Part A page 1) Step 4 - Deliver Part B to the medical practitioner or hospital concerned. Step 5 - Forward completed original to Workmans Compensation Office. Note: OCCUSAF to be telephonically notified of all medical related IOD s. Contact MARK on Cell: or LYLE on Cell: ANNEXURE II (See attached A 3) OCCUSAF to complete: Complete sections A,B and C. After the next safety committee meeting complete section D. Original copy to be retained on site. Note: LOUIS RAJAMANY TO NOTIFY DEPT OF LABOUR forthwith of all Reportable IOD s and to obtain IOSS REF NO (See attached, list of which IOD s need to be reported.) Dept of Labour: Tel: (031) B Step 1 - IMMEDIATELY NOTIFY OCCUSAF AND YOUR RESPONSIBLE MANAGER 3. A: Injured and likely to die or loses a limb or part of a limb or is likely to be permanently disabled. B: Becomes unconscious from heat exhaustion fumes or poisonous gas. C: Is unable for a period of 14 days to work or continue with the work he was doing at the time of the incident D: Where a dangerous substance was spilled E: An uncontrolled release of any substance under pressure took place F: Machinery or part thereof fractured or failed resulting in flying/falling moving objects. G: Machinery ran out of control H: Death C Step 2 - OCCUSAF/HOD TO NOTIFY DEPT OF LABOUR IMMEDIATELY TO OBTAIN IOSS NO TEL: (031) Step 3 - HOD or Health and Safety rep to complete EMPLOYERS REPORT OF as above and submit copy to DEPT of LABOUR and copy to H/O Step 4 - OCCUSAF to complete ANNEXURE II as above. page 4 of 11 Origination: 2009 { Revision 2013 }

5 ANNEXURE 1 OCCUPATIONAL HEALTH AND SAFETY ACT, 1993 (ACT 85 OF 1993) REGULATION 9 OF THE GENERAL ADMINISTRATIVE REGULATIONS RECORDING AND INVESTIGATION OF INCIDENTS A Recording of incident 1. Name of employee 2. Name of affected person 3. ID number of affected person 4. Date of the incident 5. Time of incident 6. Part of body affected Head or Neck Eye Trunk Finger Hand Arm Foot Leg Internal Multiple 7. Effect on person 8. Expected period of disablement Sprains or strains Contusion or wounds Fractures Burns Amputation Electric shock Asphyxiation Unconsciousness Poisoning Occupational Disease 0-13 days 2-4 weeks >4-16 weeks >16-52 weeks >52 weeks or permanent disablement Killed 9. Description of Occupational Disease** 10. Machine/process involved/type of work performed/exposure 11. Was incident reported to the Compensation Commissioner and the Provincial Director? YES NO 12. Was incident reported to the SAPS? (In case of fatality) 13. SAPS office and reference ** In case of a hazardous chemical substance, indicate substance exposed to B Investigation of the above incident by a person designated thereto 1. Name of investigator 2. Date of investigation 3. Designation of investigator 4. Short description of incident 5. Suspected cause of incident page 5 of 11 Origination: 2009 { Revision 2013 }

6 6. Recommended steps to prevent a recurrence D D / M M / Y Y Y Y Investigator s signature Date C Action taken by the employer to prevent the recurrence of a similar incident D D / M M / Y Y Y Y Employer s signature Date D Remarks by Health and Safety Committee Remarks D D / M M / Y Y Y Y Signature of chairperson of the health and safety committee Date page 6 of 11 Origination: 2009 { Revision 2013 }

7 OCCUPATIONAL HEALTH AND SAFETY Standard Element No. Revision No. Revision date Page Approved by Accident Reporting and Investigation 1/5 H&S STANDARD - DEFINITIONS 1. Near Misses - A near miss is where some sort of danger was posed but did not lead to the injury of any person. 2. Non-Disabling Injuries - This is where a person was injured and only received first aid treatment and continued his/her normal working functions without the loss of a shift. 3. Disabling Injuries - This is an injury, which arises out of and in the course of duty, resulting in any occupational illness, injury or disease and giving rise to any related temporary or permanent disablement as determined by a medical practitioner. Such an incident shall furthermore be classified as disabling where one or more of the following criteria are applicable: - The effected person is unable to continue with the tasks for which he/she was appointed responsible and which constitute their normal working duties. - The loss of one or more days or shifts following the shift during which the incident occurred, inclusive of weekends and scheduled off days. - All fractures and amputations, irrespective of whether or not any days were lost. Unconsciousness, irrespective of duration, resulting from any workplace exposure or incident. - Occupational illness, which necessitates medical treatment resulting in restricted duties or days off work. 4. Reportable Incidents - This is an accident in which a person has been injured and where he/she is unable to return to his/ her normal duties within 14 working days after the accident took place. An incident is also reportable when: - A person dies. - Becomes unconscious. - Suffers the loss of a limb or part of a limb. - Where a person becomes ill or is injured to such an extend that he/she is likely to die or suffer permanent physical defect. The following incidents are also reportable incidents although a person does not have to be injured in such an incident: Where a major incident occurred. (This is an occurrence of catastrophic proportion, resulting from the use of plant and machinery or from activities at the workplace) Where the health and safety of a person was endangered and where: - A dangerous substance was spilled. - The uncontrolled release of any substance under pressure took place. - Machinery fractured or failed resulting in flying, falling, uncontrolled moving objects. - Machinery ran out of control. page 7 of 11 Origination: 2009 { Revision 2013 }

8 WHAT MUST I DO WHEN I HAVE AN ON SITE? DEPARTMENT OF LABOUR NOTIFICATION A Reportable Accidents 1. As soon as an accident occurs, determine if the accident is a reportable or non-reportable incident. If the accident complies with the provisions of the definition of a reportable incident, the accident must be reported to the Department of Labour and the Workman s Compensation Commissioner (WCA). 2. Where an accident conforms to the provisions of a reportable incident, the accident must be reported to the Department of Labour within seven (7) days of the accident date on a WCLl form. This is the same form used to report an accident to the Workman s Compensation. It is suggested that a copy of the WCLl form is made and sent to the local Department of Labour Office as well as phoning the Department of Labour to notify them of the accident that took place. 3. For each reportable incident a file must be opened where the following must be filed: - All correspondence with the Department of Labour - Written notes of telephone conversations with the Department of Labour - Accident investigation reports - Photos - Statements 4. In case of a reportable accident, the following procedure must be followed: 4.1 Notify the Department of Labour immediately of the accident (notify the Branch Manager and OCCUSAF Consultant of the accident) - WCLl Form - Per telephone / Fax 4.2 Do a full investigation into the accident as per GRINDROD INTERMODAL Accident Investigation Procedure. 4.3 Complete Annexure 1 Form 4.4 Complete WCA forms and send off to the Workman s Compensation 4.5 Keep all records on file B Non-Reportable Accidents 1. Where an accident does not comply with the provisions of a reportable incident, the accident does not have to be reported to the Department of Labour Offices. If there is any doubt, please rather contact the Branch Manager or OCCUSAF Consultant for clarification. 2. In case of a non-reportable accident, the following procedures must be followed: 2.1 Investigate accident as per GRINDROD INTERMODAL Investigation Procedure 2.2 Complete Annexure 1 form 2.3 Discuss Annexure 1 form at Health and Safety Committee Meeting 2.4 Implement actions decided on to prevent occurrence 2.5 Keep Annexure 1 forms on central file page 8 of 11 Origination: 2009 { Revision 2013 }

9 OCCUPATIONAL HEALTH AND SAFETY Standard Element No. Revision No. Revision date Page Approved by Accident Reporting and Investigation 1/4 1. Which occupational injuries must be reported? All occupational injuries or alleged occupational injuries that entail medical expenses and/or absence from work for more than three days must be reported within seven days in the prescribed manner. Delay in reporting a reportable accident or alleged accident is a criminal offence. 2. Reporting procedure Employers report of accident Complete part A of the W.CI.2 form. (Employers report of Occupational Injury) This form must be signed by the Employer or designated person and the date must be provided. Step 1 Employers report of accident Complete part A of the W.CI.2 form. (Employers report of Occupational Injury) This form must be signed by the Employer or designated person and the date must be provided. Step 2 Copy to doctor / hospital Detach part B where perforated and forward it to the doctor or hospital without delay. In minor cases, part B must accompany the injured person to the doctor. Step 3 Employers report of accident Complete part A page 2 of the W.CI.2 Form. Step 4 Reporting to Compensation Commissioner Forward the completed form W.CI.2 pages 1 and 2 without delay to the following address: Compensation Commissioner PO Box 955 Pretoria MAKE SURE THAT COPIES ARE KEPT OF ALL CORRESPONDANCE, FORMS ETC. WITH THE COMPENSATION COMMISSIONER FOR LATER REFERENCE Step 5 First medical report After treatment from the doctor, the doctor will issue the Employer with a first medical report - W.CL.4. On receiving the first medical report, the Employer must send this report to the Compensation Commissioner without delay. page 9 of 11 Origination: 2009 { Revision 2013 }

10 Step 6 Accepting liability On receipt of the Employer report of the accident (W.CI.2) and the First medical report (W.CL.4), the claim will be considered by the Compensation Commissioner. If liability is accepted by the Compensation Commissioner, the Commissioner will issue the Employer with a postcard (W.CL.56). The claim number will appear on the postcard. If liability cannot at that stage be accepted, an acknowledgement card (W.CL.55) will be addressed to the Employer providing the claim number allocated. Step 7 Progress medical reports Every time the injured persons attend a doctor s visit, the doctor will issue him/her with a progress medical report (W.CL. 5). This report must be sent to the Compensation Commissioner without delay. Step 8 Final medical report As soon as the doctor feels that the injured person is fit to resume his/her normal functions, he will issue the Employer with a final medical report (W.CL.5) Step 9 Resumption report As soon as the Employer has received the final medical report (W.CL.5) the Employer must now complete a resumption report (W.CL.6) The resumption report is very critical. This is an indication to the Compensation Commissioner along with the final medical report (W.CL.5) that the claim has been finalised and that the injured person has resumed his / her duties. WITHOUT RECEIVING THE RESUMPTION MANAGEMENT REPORT (W.CL.6) THE COMPENSATION COMMISSIONER WILL NOT PAY OUT MONEYS OWED TO THE MANUFACTURING UNIT. THE FINAL MEDICAL MANAGEMENT REPORT (W.CL.5) TOGETHER WITH THE RESUMPTION MANAGEMENT REPORT (W.CL.6) MUST BE SENT TO THE COMPENSATION COMMISIONER WITHOUT DELAY. 3. FATAL OCCUPATIONAL INJURIES (S) If the accident resulted in the Employee s death, the following documents must be submitted without delay: - Documentary proof indicating the cause of death If the Employee leaves a widow/widower and / or children under the age of 18 years as dependants: - A marriage certificate - Birth certificate / baptismal certificates / sworn statements regarding the age of the widow/widower - Birth certificates / baptismal certificates / sworn statements regarding the ages of all of the children. A claim for compensation W.CL3 page 1 and 2. - A statement by the dependant widow/widower of the deceased Employee W.CL32 - A specified burial account and if paid also a receipt page 10 of 11 Origination: 2009 { Revision 2013 }

11 4. OCCUPATIONAL DISEASES In the case of an alleged occupational disease, the Employer must irrespective of the W.CL 1 also submit the following documents: - A first medical report for an occupational disease W.CL22. - A claim for compensation for an occupational disease W.CL A progress medical report W.CL26 must be submitted monthly until the Employee s condition has become stabilised, where after a final medical report W.CL26 must be submitted - In case of deafness as a result of excessive noise at the Employee s workplace, audiograms must also be submitted 5. TRANSPORT OF AN INJURED EMPLOYEE The reasonable expenses incurred for the conveyance of an employee, injured in an accident, to the hospital or to his/her residence, will be refunded from the Compensation Fund. 6. GENERAL INFORMATION - Always make copies of all correspondence with the Compensation Commissioner and keep this on a central file - When accounts are sent off to the Compensation Commissioner, attach a copy of Part A of the W.CL 2 with each account - Ensure that all correspondence with the Compensation Commissioner, the claim number is clearly indicated Ensure when filling in the forms, that all names, surnames etc are filled in and spelt correctly. page 11 of 11 Origination: 2009 { Revision 2013 }

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