Incident and Accident Reporting

Clarkson University requires that all injuries sustained while on University property and/or while participating in University recognized activities be reported.  This report should be completed no matter how minor the injury may have been.  A Clarkson representative must complete all sections of this form as soon as possible (within 24-48 hours is preferred) after the injury is first reported.  Once completed, a copy of this report must be sent to the Human Resources Department Box 5542.

 

 Accident Reporting Procedure (pdf document)

 

ACCIDENT REPORTING PROCEDURE

A.  Personal Injuries or Accidents

B. Motor Vehicle Accidents

C. Property Damage

Incident Report Forms

 

  1. PERSONAL INJURIES OR ACCIDENTS

    1.      Accident/incident reports are not required for minor injuries such as scrapes, bruises, sprains, etc. The accident/incident report is required for serious illnesses, repetitive motion or muscular skeleton issues, chipped or broken teeth, extensive lacerations involving sutures, falls involving unconciousness, dislocations, incidents involving water which require resuscitation, or any injury requiring a hospital stay.

     

2.      Death and Serious Multiple Injuries to any Individual

Priority attention: care for injured, stabilize the situation

  • Call Campus Safety & Security (x6666), 911, village police or ambulance as appropriate.
  • Campus Safety & Security will notify the University Emergency Response Team vial texting system and the team will initiate a conference bridge.
  • Campus Safety & Security or other University representative shall remain at the scene.
  • Make NO statements to anyone other than the police, a supervisor, Clarkson University Legal Counsel, Risk Management, or University Relations.
  • Proper spokesperson (Dean of Students, Human Resources, Village Police, etc) must immediately contact the parent, guardian, or next of kin to the injured and inform them of the situation.
  • If the victim is an employee on the job, Campus Safety & Security will notify Risk Management.  Risk Management will contact OSHA to report the incident. 
  • When appropriate and if possible within 12 hours, complete the appropriate Incident Report Form (Part A for employees, Part C for non-employees) and take notes; DO NOT conclude FAULT.  FACTS only.  
  • Refer all media to University Media Relations.  DO NOT MAKE ANY COMMENT. DO NOT SPEAK DIRECTLY TO THE PRESS, including but not limited to reporters, photographers, and camera crew personnel.
  • Campus Safety & Security shall contact Student Support Services personnel can to assist with Mental Health concerns of all individuals involved.

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3.      Injuries to Employees  

  • Employees who are injured at work should seek medical attention.
  • For a life threatening emergency:
    • Call 9-911.  Tell them exactly where you are on campus. 
    • NEVER transport an injured employee in your personal vehicle.  Call 9-911.  
    • Automatic defibrillatorsare located at the Cheel Info Desk, Fitness Center Desk, and Campus Safety & Security vehicle.
  • For minor injuries:
    • Obtain medical attention either at the Canton-Potsdam Hospital or with their personal physician.  
    • NEVER transport an injured employee in your personal vehicle.  Call 9-911. 
    • Notify Campus Safety & Security IMMEDIATELY for a chemical, biological, or radioactive material exposure.  Campus Safety & Security will contact the University Safety Officer or Environmental Health & Safety Manager for assistance.
    • Notify your supervisor as soon as possible regarding the incident or injury. 
    • The employee must complete the form “Part A: Employee Incident Report” as soon as possible and submit it to Human Resources. 
    • The injured employee’s supervisor must complete an investigation into the causes of the incident and complete “Part B: Supervisor’s Investigation Report”.
  • Clarkson University requests that employees complete “Part C: CLAIMANT'S AUTHORIZATION TO DISCLOSE HEALTH INFORMATION”.  While the University cannot require you to complete this form, it is recommended.

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4.      Injuries to Students and the General Public (non-employees)

Non-employee personnel who are injured while on Clarkson University’s campus should complete  “Part D: Non-Employee Incident Report”. 

 

5.      Response To Specific Incidents:

Minor cuts and punctures

 Vigorously wash injury with soap and water for several minutes.
Major cuts and abrasions

If the person is bleeding profusely, Call 911 (9-911 from campus phone).

Keep victim lying down and raise the bleeding part higher than the rest of the body if the cut is severe.
Impalement by foreign object DO NOT REMOVE THE OBJECT.  Seek medical attention immediately.
Splash in eye

Using an emergency eye wash, immediately flush eye with water continuously for 15 minutes.

Hold the eyelid open.
Contamination to the body

Using an emergency shower, immediately remove contaminated clothing and drench skin with water.  Flush area for 15 minutes. Conventional showers may be used in available areas.
Thermal burns

If skin is unbroken, submerge the burned area in clean water.

Do not break any blisters, or use any medication.
Poisoning by ingestion

Do not induce vomiting.

Supply the Material Safety Data Sheet (MSDS) for emergency personnel.

IF THE VICTIM IS UNCONSCIOUS, Call 911 IMMEDIATELY (9-911 from campus phone).
Poisoning by inhalation

Do not become a victim yourself by exposure the same poison while rescuing the victim.  Call 911 (9-911 from campus phone).

Where possible, transport victim to uncontaminated air immediately.

IF THE VICTIM IS UNCONSCIOUS, Call 911 IMMEDIATELY (9-911 from campus phone).
Clothing fire

Immediately DROP TO THE FLOOR AND ROLL.

If someone else’s clothing catches fire, knock that person to the floor and roll them around to smother the flames.  A person may panic if his/her clothing catches fire and may run.  This can result in more severe burn injuries.

 

  1. MOTOR VEHICLE ACCIDENT

  2.  

1.      For an incident involving a university vehicle, refer to Clarkson University’s Vehicle Usage Policy.

  • For incidents involving Facilities & Services Vehicles, contact your immediate supervisor.  Your supervisor will contact Risk Management.
  • For all other incident involving university vehicles, notify Risk Management as soon as possible.

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2.      For an incident involving a private vehicle on Clarkson University’s campus, contact Campus Safety & Security (268-6666) and the Village of Potsdam Police (911) to complete a police report.

 



 

  1. PROPERTY DAMAGE

  2.  

1.      Clarkson University's insurance provides coverage for catastrophic loss of property due to theft, vandalism, etc. or destruction by wind, water, freeze, etc. Any loss or damage to University property should be reported to Risk Management.  Personal property is not covered by Clarkson University.

 

2.      Property of others under the care, custody and control of Clarkson University is insured the same as owned property. In order for this property to be covered there must be a document on file, completed before the date of loss, showing Clarkson University has this responsibility.

 

3.      All sudden and accidental losses or damage with significant damage to Clarkson University property should be reported immediately. Typical losses include theft, vandalism, water damage, wind damage, floods, lightning damage, etc.

 

4.      Property Loss of Damage, Procedure for Insurance Recovery

  • IMMEDIATELY notify the Office of Risk Management by telephone at 268-7722 or fax at 268-4475. Also call Campus Safety & Security on all thefts and vandalism (268-6666).
  • Provide Risk Management with the following information:
    • Date loss occurred
    • Time the loss occurred
    • Kind of loss (theft, water damage, fire, wind, etc.)
    • Location of the loss
    • Dollar estimate of the loss
    • Description of loss and/or damage 
    •  Name of contact person and telephone number
  • If property has been damaged by fire, water, etc., Risk Management will indicate what can be done to ensure that no further damage occurs and steps to take which will not jeopardize your insurance claim.

 

Incident Reports: