Incident Reporting Form
|Incident and hazard reporting||Incident and Investigation Report can be found and downloaded on this page, as well as instructions on where to submit. Information on the Incident Management Program can also be found on this page.||webpage|
- Promptly seek appropriate medical attention.
- Notify your supervisor as soon as possible of injury/illness, relevant healthcare and restrictions.
- Complete the Incident and Investigation Report by providing information about the incident. Note that your supervisor is responsible for submitting the report to the Safety Office within 24 hours.
- Provide information as required to the Workplace Safety & Insurance Board (WSIB), and participate in UWaterloo's Return to Work program.
- Ensure the injured employee receives prompt and appropriate first aid and/or medical attention.
- Provide immediate transportation for the injured employee to emergency healthcare, if necessary.
- Complete the Injury and Investigation Report and submit within 24 hours to the Safety Office. Note that department heads will need to sign off all incident reports requiring mandatory investigation. If report is incomplete, resubmit form when all signatures have been obtained and corrective actions identified.
- Conduct an investigation and take corrective actions to prevent recurrence.
- Identify potential suitable modified work for the employee and participate in the Return to Work process.
- Maintain communication with the injured employee.
In the event of a critical injury, supervisors are responsible for:
- Obtaining immediate emergency medical attention.
- Securing the incident site and ensuring that further injury is prevented.
- Calling Police Services at 519-888-4911 or ext. 22222 from an on-campus phone to report the critical injury.
- Ensuring that the site remains secure until cleared by Police Services or a representative from the Safety Office.
- Cooperating with the Safety Office and Ontario Ministry of Labour throughout the course of an investigation.