Module 11 - Brittany Bruce

Accident and Incident Reporting
At Benjamin’s Foundation, we know that accident/incidents can occur in the work environment.
Therefore, we want to educate our team early on during their onboarding trainings to confidently
report any situation that could arise. We are committed to training all employees to report incidents in
a timely manner. This will give the supervisor enough time to complete a thorough investigation as
well as put preventative measures in place and reinforce.
When to Report an Incident:
All on-the-job incidents need to be reported as soon as possible so the investigative process can
begin right away. We don’t want our supervisors missing an important detail due to a lag in reporting
time. Reporting an incident within 24 hours will ensure that preventative measures can be established
quicker to prevent reassurance.
Types of Incidents that should be Reported:
Benjamin’s Foundations encourages all employee to report any incident regardless of severity. Minor
injuries like small cuts from breaking a glass, does not require a written report but employees may
report if they would like to. All major incidents on the other hand, will require investigation and
organization action.
Please see the following incidents that require reporting:
 Fatalities
 Injury to skin such as burns, bruises, etc.
 Contamination from hazardous substances or transmission of diseases
 Poisoning
 Broken, dislocated or amputated limbs
 Loss of hearing, sight, taste or smell
 Loss of consciousness
 Any other injury that requires hospitalization or medical care
Anytime an employee needs medical coverage, that incident must be reported as soon as possible to
ensure coverage can be approved following the investigation.
We also want all employee to report any of the following possible incidents:
 Slippery surfaces
 Water of gas leak
 Damage to structure of building
 Breaking windows
 Explosions
Reporting Procedure:
When an employee witnesses or is involved in an incident it was be immediately reported to their
immediate supervisor, HR Manager or through an online system within 24 hours. This also applies to
any potential incidents so the accident can be prevented. The incident form needs to be completed
and submitted. The form can be found on the company portal and will include the place the incident
occurred, date, time, people involved, there involvement in incident and other details.
Once the form as been submitted the employee filing the report will be called in for questioning to
provide an additional details if needed.
Any employee that does not report an incident or is discovered to know about an incident will face
disciplinary action up to termination. Legal repercussions could be taken if an employee is directly
involved a fails to report.
Accident and Incident Reporting Form
Employee/Volunteer Filling Report: Title: Email:
Address: Phone:
Date of Incident: Time of Event: Did it occur on organization

grounds?
 Yes  No
Location of Incident:
Was Transport to Hospital Provided by Employee or Ambulance?
Description of Incident: (Provide factual account of the incident; provide who was involved and how
the incident occurred.) Use additional sheet if needed
Was Medical Attention Required or Recommended for this Incident?

 Yes  No
Witnesses Name and Contact Information:
1.
2.
3.
Signature of individual completing Date:

report:
Additional Details Following Investigation: *For Supervisor Use
Corrective Action Taken: *For Supervisor Use
Action Taken By:
Supervisor Signature: Date:

References
Lohrey, J.(2020) Incident Investigation & Reporting Policy. Retrieved from:

https://smallbusiness.chron.com/incident-investigation-reporting-policy-77255.html
Stumhofer, E. (n.d.) Hitting the Nail on the Head: Prioritizing Safety at Your Nonprofit.
Retrieved from: https://nonprofitrisk.org/resources/articles/hitting-the-nail-on-the-head-
prioritizing-safety-at-your-nonprofit/

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Accident and Incident Reporting

Accident and Incident Reporting Form

Employee/Volunteer Filling Report: Title: Email:

Date of Incident: Time of Event: Did it occur on organization

Was Transport to Hospital Provided by Employee or Ambulance?

Was Medical Attention Required or Recommended for this Incident?

Signature of individual completing Date:

Additional Details Following Investigation: *For Supervisor Use

Corrective Action Taken: *For Supervisor Use

Action Taken By:

Supervisor Signature: Date:

Lohrey, J.(2020) Incident Investigation & Reporting Policy. Retrieved from:

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