Safety & Well-being
Forms & Documents
- Accident / Incident Report Form
- Accident / Incident Reporting Procedure
- Injury Incident Investigation Procedure
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Accident / Illness / Incident Reporting
Whenever you suffer a workplace accident or illness, or experience a close call, the situation must be reported. This page will assist you on what actions to take and in completing the Accident/Illness/Incident Report Form.
Critical Injury Steps
If a workplace injury meets the definition of a critical injury, take the following steps:
- Ensure the accident victim has received proper first aid, then:
- Immediately secure the accident scene and prevent any evidence from being removed prior to the completion of an investigation.
- Contact Health & Safety by emailing hsw@uwo.ca or by calling Human Resources at x82194, and contact Western Special Constable Service at 911.
For further information or if you have a specific question, please contact Louise Koza at lkoza@uwo.ca or call 519-661-2111 extension 85540.
Accident / Illness / Incident Reporting Steps
Personal injury accidents, occupational illness, property damage over $250 and close calls which in another set of circumstances would result in personal injury, must be reported.
Definition of Occupational Illness
Priority Steps
- Medical assistance and first aid are your priority.
- The accident/incident scene must be secured and made safe to prevent further accidents until the investigation is completed.
Steps for Supervisors
- The supervisor conducts the investigation and completes the Accident/Illness/Incident Report Form. Complete the upper part of the form, working with the person(s) involved. If there is a dispute separate reports may be filed.
- Analyze contributing factors and from these determine the corrective actions needed. Indicate these on the form.
- Sign off on the form once completed and fax to Employee Health & Well-being at 519-661-3420 or 83420.
- Distribute copies of the Accident/Illness/Incident Report as follows:
- Workplace/Student Health Services (UCC 25)
- Budget Unit Head/Supervisor or Chair
- Employee/Student/Visitor
- Originator
- Applicable Employee’s Union/Staff Group – JOHSC Rep
- UWOSA – UCC 255
- PMA – UCC 351
- CUPE 2361 - FM - SSB 1320
- CUPE 2692 HS – Perth Hall 152
- OPSEU 102 – LwH 1257
- IUOE
- PSAC 610 – UCC 271
- SAGE – STVH 3107P
- UWOFA - Elborn
Remember, our first goal is always prevention!
Critical Injury Definition
Serious accidents which meet this definition must be reported to the Ministry of Labour immediately.
A critical injury means an injury of a serious nature that:
- places life in jeopardy,
- produces unconsciousness,
- results in substantial loss of blood,
- involves the fracture of an arm or a leg but not a finger or toe,
- involves the amputation of a leg, arm, hand or foot but not a finger or toe,
- consists of burns to a major portion of the body, or
- causes the loss of sight in an eye; ("gravement blessé")
“medical attention” means treatment from a legally qualified medical practitioner or a registered nurse who holds an extended certificate of registration under the Nursing Act, 1991. (“soins médicaux”)
Source:
Occupational Health and Safety Act of Ontario, Regulation 420/21
Occupational Illness Definition
An occupational illness as defined in the Occupational Health and Safety Act (section 1 (1)) is “a condition that results from exposure in a workplace to a physical, chemical or biological agent to the extent that the normal physiological mechanisms are affected and the health of the worker is impaired thereby and includes an occupational disease for which a worker is entitled to benefits under the Workplace Safety and Insurance Act, 1997”.
Examples of Occupational Illnesses
- Asbestosis
- Dermatitis (skin rashes and inflammation)
- Occupational asthma
- Infectious diseases (tuberculosis, hepatitis, norovirus,influenza, chickenpox)
- Certain types of cancer
- Noise induced hearing loss
- Chronic obstructive pulmonary disease
- Silicosis
Source:
Health and Safety Ontario
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