Incident Report

 

Incident Reporting Standards

For all injuries that require any treatment above first aid, managers must fill out an incident report (see below)

● All first aid incidents do not need to be reported to ADP

● For all life threatening emergencies, call 911 immediately before reporting your claim

● All fatalities or serious injuries need to be reported to ADP and OSHA within 8 hours

● All “In-patient” hospitalizations, amputations, or eye loss need to be reported with ADP by manager within 24 hours ○ OSHA defines in-patient hospitalization as a formal admission to the in-patient service of a hospital or clinic for care or treatment. Treatment in an Emergency Room only is not reportable.

Resources

Resources Reporting an injury claim through ADP(800) 553-4681

● Gathers all necessary information over the phone – eliminating the need for managers to complete and submit any claim forms

ADP nurse triage program(888) 551-5605

● Use to determine what the level the injury qualifies as

○ i.e. someone cuts their hand and you’re unsure if it’s first aid or a hospital visit

OSHA 24-hour hotline – can report by

1. Call OSHA directly at 1-800-321-6742

2. Call the closest OSHA Area Office during normal business hours at 813-626-1177

3.Report Online https://www.osha.gov/ords/ser/serform.html

When reporting be prepared to supply: Business name; names of employees affected; location and time of the incident, brief description of the incident; contact person and phone number

Submit Report

  • Employee Details

  • MM slash DD slash YYYY
  • :
  • Description of Injury

  • MM slash DD slash YYYY
  • :