Injury & Incident Report Form

Injury and incident investigations are conducted to identify the cause(s) that led, or could have led, to personal injury, occupational illness or property damage. Although investigating injuries is usually reactive since someone has already been injured, they are nonetheless valuable in helping to prevent a recurrence. Furthermore, legislation requires Nipissing University to report and investigate certain types of injuries and illnesses.

All injuries and incidents, including damage to property, regardless of severity, are to be reported by completing the Injury and Incident Reporting E-Form found at the link below:

https://forms.office.com/r/7ktCY6ztFk

For instructions on how to complete the injury/incident form please use the following link to access a 'how to' PDF /media/45451

Note:  If you require the form in an accessible format please email michellb@nipissingu.ca .

Responsibilities

Supervisors/Deans

Supervisors/Deans are responsible for:

  • Ensuring that the injured person receives first aid immediately, if required.
  • Arranging to have the individual transported to the hospital to receive medical attention, if required.
  • Securing the area to ensure that evidence is not disturbed if the victim suffered a critical injury or fatality.
  • Contacting the Human Resources Generalist - Health, Safety & Wellness immediately in the event of a critical injury or fatality.
  • Obtaining the name of any witnesses.
  • When requested, assisting the injured person complete the “Injury and Incident Report E-Form”.
  • Submitting the form within 24 hours of the occurrence*.
  • Following-up to ensure recommendations made during the investigation are implemented and adequate.

* The form may not be delayed for lack of information.

The “Injury and Incident Report E-Form” must be completed and submitted to the Human Resources within 24 hours of first being notified of an injury. The WSIB levies a fee for late reporting of a lost time injury or health care claim. Where this late reporting is a result of the failure of a department to report the injury within the required timeline, the fine may be charged to that department.

It is strongly recommended that Supervisors/Deans name an alternate to complete this task in case of their unavailability.

Injured person or person reporting a near miss

Employees/students/visitors are responsible for:

  • Obtaining first-aid or health care (medical aid) in cases of injury and reporting such treatment to their Supervisor, Dean or host.
  • Reporting an injury/incident to their Supervisor, Dean or host immediately, or as soon as possible.
  • Co-operating with the completion of the “Injury and Incident Report E-Form” if available.
  • Co-operating during the investigation, if assistance is requested.