Non-Occupational Accident Report Form for Western Carolina University
This form is used to report non-occupational accidents at Western Carolina University. It is necessary for recording incidents involving students, faculty/staff, or visitors. Completed forms should be submitted to the Safety and Risk Management Office.
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How do I fill this out?
To fill out this form, ensure that all relevant details about the accident are accurately provided. Include the date, time, location, and description of the incident. Ensure that any corrective actions taken are also mentioned.
How to fill out the Non-Occupational Accident Report Form for Western Carolina University?
1
Provide the date and time of the accident.
2
Specify the location and course details.
3
Fill in the injured person's name and contact information.
4
Describe the nature of the accident and the injury.
5
Submit the completed form to the Safety and Risk Management Office.
Who needs the Non-Occupational Accident Report Form for Western Carolina University?
1
Students involved in non-occupational accidents to report the incident.
2
Faculty or staff members who witness or are involved in an accident to record details.
3
Visitors who experience accidents on WCU property for documentation.
4
Safety and Risk Management to maintain accident records.
5
Supervisors to ensure corrective actions are implemented.
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What are the instructions for submitting this form?
Submit the completed form to the Safety and Risk Management Office at Western Carolina University. Options for submission include: Email: safety@wcu.edu, Fax: 828-227-7443, Online submission form: available on the university's Safety and Risk Management webpage, Physical address: Safety and Risk Management Office, Western Carolina University, Cullowhee, NC 28723. Ensure all required fields are accurately filled out before submission.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates for this form in 2024 and 2025. Ensure the form is submitted as soon as possible after the accident occurs.
What is the purpose of this form?
The purpose of this form is to document non-occupational accidents that occur on Western Carolina University's campus or other WCU-owned properties. Recording these incidents helps in identifying potential hazards and implementing corrective measures to prevent future accidents. By providing detailed information about the incident, the form assists the Safety and Risk Management Office in maintaining accurate records and ensuring a safe environment.
Tell me about this form and its components and fields line-by-line.
- 1. Date of Accident: The date when the accident occurred.
- 2. Time: The time when the accident happened.
- 3. Location: The specific building and room where the accident took place.
- 4. Course: The course and section details if applicable.
- 5. Name and Telephone of Injured: The name and contact details of the injured person.
- 6. Name and Telephone of Witness(es): The names and contact details of any witnesses.
- 7. Relationship: The relationship of the injured person to the university (e.g., faculty, staff, student, visitor).
- 8. Nature of Accident: A description of the type of accident (burn, cut, etc.).
- 9. Apparent Seriousness of Injury: An assessment of the injury's severity (minor or major).
- 10. Briefly Describe What Happened: A brief description of the events leading to the accident.
- 11. Action Taken: Details of any immediate actions taken (treatment, first aid, etc.).
- 12. Report Completed by: The name of the person completing the report.
- 13. Department: The department of the person completing the report.
- 14. Date: The date when the report was completed.
What happens if I fail to submit this form?
Failing to submit this form may result in inadequate documentation of the incident and lack of necessary follow-up actions.
- Lack of Record: Missing or incomplete records of the accident.
- Safety Risks: Unreported hazards may not be addressed, posing safety risks.
- Non-Compliance: Failure to comply with university reporting procedures.
How do I know when to use this form?
- 1. Student Accidents: When a student is involved in a non-occupational accident.
- 2. Faculty/Staff Incidents: When faculty or staff experience or witness an accident.
- 3. Visitor Accidents: When a visitor is involved in an accident on campus.
- 4. Near Misses: To report incidents that could have resulted in injury.
- 5. Preventive Documentation: To document accidents for future preventive measures.
Frequently Asked Question
What is the purpose of this form?
The form is used to report non-occupational accidents at Western Carolina University.
Who needs to fill out this form?
Students, faculty, staff, and visitors involved in or witnessing an accident on WCU property.
How do I submit the completed form?
Submit the completed form to the Safety and Risk Management Office.
Can I edit this form online?
Yes, you can edit the form on PrintFriendly using our PDF editor.
How can I sign the form?
You can sign the form using the signing tool available on PrintFriendly.
Can I share the completed form?
Yes, you can share the completed form via email or a shareable link on PrintFriendly.
What details are required in the form?
The form requires details like date, time, location, injured person's info, and description of the accident.
Where can I find this form?
Contact the University Office of Safety and Risk Management to obtain the form.
Is this form used for Worker's Compensation?
No, this form does not replace Worker’s Compensation reporting requirements.
Do I need to submit the form immediately?
Yes, the form should be completed at the time of the accident or as soon as feasibly possible.
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