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spacer spacer Accident Reporting and Investigation

In the event of a fire, large chemical spill, or any incident where immediate emergency medical attention is needed, please call 911 immediately!

If you are not sure outside help or medical attention is needed, contact Campus Safety at 603-358-2228. In the event of a motor vehicle accident, small gas spill, or small chemical spill, contact Campus Safety at 603-358-2228.

An employee who experiences an accident or is injured while at work should report information about the incident immediately to his or her supervisor. If non urgent medical attention is required, Keene State College worker's compensation medical providers are either the Emergency Room at Dartmouth Hitchcock Keene or the Dartmouth Keene Clinic Occupational Health department.

Accident investigation and reporting must be completed as soon as possible after the incident occurs, but no later than 48 hours after the incident. The supervisor is responsible for gathering the information from the employee and for the completion and submission of the forms. For injury or illness reporting, there are sections which require the employee to describe the incident. The goal of the accident investigation is to determine the root cause of the incident and prevent recurrence. It is not to assign blame or fault. Remember to ask who, what, where, when and why - use the form below for guidance in finding out what happened. Finally, if a corrective action is recommended, it is important that this action is implemented in a timely fashion. If you have any questions, please contact the EHS Coordinator at 603-358-2879.

The incident report form should be used to report any accident, injury, occupational illness, or "near miss" incident involving a KSC employee, student, contract employee, or visitor to the campus. "Near miss" incidents should be reported so that we can correct any identified hazards that could lead to an accident (for example, a broken step or pothole in a walkway). The form must be filed with the KSC Human Resource Management Office within two days of the date of the incident/injury/illness.

Instructions:

Section 1 must be completed for any type of incident or near miss.

Section 2 must be completed if there has been an injury.

Section 3 must be completed by a supervisor or appropriate campus official for any incident involving an employee. Incomplete forms will be returned to the supervisor.

Section 4 must be completed by a supervisor or appropriate campus official for any employee who sought medical attention.

Accident Statistics

Spill Report Template


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