Clarke University has an established accident/incident investigation program to determine the underlying causes of accidents and incidents, and to prevent similar occurrences. Clarke University will investigate any accident of incident that involves an employee, student, or visitor on campus.
Supervisors, managers, teachers, and staff must ensure the completion of the Injury & Incidents Report Form for each accident, exposure, occupational illness, incident, or near miss incident that is reported, or is observed by them. An investigation must then be conducted by the supervisor, staff member, or supervising adult using the Investigative Report for Injury & Incidents. An accident investigation is an analysis and account of an accident based upon factual information, gathered by a thorough examination of all factors involved. It includes definite action to be taken to prevent a recurrence.
The Injury & Incidents Report Form and the Investigative Report for Injury & Incidents should be completed and forwarded to the office of safety and security within 24 hours of the incident. Forms can be obtained at the office of safety and security, lower level of Mary Josita Hall, G27, x6326 or by clicking below:
Please download the form prior to filling it out. Filling it out and then downloading may result in losing the filled in spaces.
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The forms can be printed, filled out, and returned to the safety and security office.
Purpose of Investigation
The purpose of the reporting and investigation is to initiate actions that will prevent further accidents. The goal is to find the cause(s) of the occurrence. The result of the analysis will be physical or mechanical improvements, or better employee training. Supervisors, managers, teachers, and staff can play an important role in the process by ensuring that the Injury & Incidents Report Form and Investigative Report for Injury & Incidents is accurately completed.
Accidents- Injuries or illnesses which are OSHA recordable, result in workers compensation claims for either medical or lost time benefits, or require medical treatment other than first aid.
Sports Injuries- These need not be reported unless there is reason for further investigation
Incidents- Injuries or illnesses which are treated by first aid only, or property damage which does not involve injury or illness
Near Miss Incident- Incidents which could have, but did not result in, injury, illness, or property damage.
Employees- Students, faculty, or staff who are on the Clarke payroll or work study students.
Students- Anyone enrolled in a class at Clarke and under the supervision of a teacher.
Injury & Incidents Report Form
This form is required to report any accident, incident, or near miss that involves a student, employee, or visitor at Clarke University. It is also required for incidents involving university property on or off campus (i.e. motor vehicle accident off campus), Clarke employees on official business off campus, or Clarke students on school sponsored trips.
Investigative Report for Injury & Incidents
This form is required to investigate any accident or incident, and to suggest preventive action. This form is to be completed by the immediate supervisor of the person involved in the accident/incident.