邢唷��>� BD��A��欹�O ��bjbj@鉆� .$"墡e"墡e�B��z z ��8'�z$&;QQQQ,,,�#�#�#�#�#�#�#$�&�V)�$�,,,,,$��QQ�4$RRR,^�Q�Q�#R,�#RRV�"@}#Q��P峈蜉y��F�"�#J$0z$#x*��*}#*�}#h,,R,,,,,$$��,,,z$,,,,��*,,,,,,,,,z �: Timing for completion of forms: After an incident has occurred, (within 24 hrs. or less) the employee should report it to their supervisor. The supervisor should provide the employee with the Employee Incident Report form for completion. When complete, a copy can be faxed to X82228 with the original sent in the inter-office mail to Jillian Townsend, Maintenance Building Rm 120A or HYPERLINK "mailto:jetownsend@salisbury.edu" jetownsend@salisbury.edu Notes: Obviously, the first priority is the employee抯 well-being. It may be advisable to have the employee complete the form after seeking proper medical care. (If employee is unable to drive to the appropriate medical care provider, it is the responsibility of the supervisor or his/her designee to call for transportation. In the case of a medical emergency, an ambulance should be called.) Depending on the circumstances, the form may not be able to be completed until after all information is available, (for example: treatment administered, days away from work, job transfer or restriction) and return to Human Resources. If employee is out of work, the supervisor may complete the Employee Incident Report form via a phone interview with the employee and return to Human Resources. He/she should check the 損hone interview� box and sign and date on the appropriate line. The supervisor should complete the Supervisor抯 Incident Report form and submit via fax and hard copy to Human Resources ASAP. If there are any witnesses to the incident, the Witness Incident Report form should be completed and returned to Human Resources. As a general rule, 91制片厂 has up to 3 days, from time of incident, to report the information to IWIF (Injured Workers� Insurance Fund) for further investigation. Prompt attention and completion of each form (including Witness Incident Report form梚f applicable) will ensure that the employee抯 injury gets proper treatment, medical bills are paid and employee is properly compensated for lost time. Completing the Forms--Key Points: Completeness/Accuracy: Provide as much information as possible. Lack of information requires follow-up calls and/or visits to remedy. Be as accurate and detailed as possible. *Building name or area: If the incident occurred within or next to a building, reference that location. If the incident was outside, reference the general location with available details. For example: 揜ed Square� or 揝idewalk between Devilbiss & Henson�. *Location Detail: Use this area to provide added information that will help to pinpoint where the accident occurred. For example: 搉ear water fountain� or 揳t dumpster�. *Describe, in your own words, how the incident occurred including any conditions, object or substance that may have contributed to the incident or injured the employee: Example: employee was injured while moving a hot pan from a stove to the counter. *What was the injury or symptoms: be a specific as possible梚ncluding body part(s) affected. Example: burn on right forearm. Include, if applicable, any symptoms. Examples: fainting, dizziness, blurred vision. *First Aid: is defined as using non-prescription medications at non-prescription strengths; administering tetanus immunizations; cleaning, flushing, or soaking wounds on the skin surface; using wound coverings such as bandages, BandAids, gauze pads,, etc., or using SteriStrips or butterfly bandages; using hot or cold therapy; using any totally non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.; using temporary immobilization devices while transporting a victim (splints, slings, neck collars or back boards); drilling a fingernail to relieve pressure or draining fluids from blisters; using eye patches; using simple irrigation or a cotton swab to remove foreign bodies not embedded in or adhering to the eye; using irrigation, tweezers, cotton swabs, or other simple means to remove splinters or foreign materials from areas other than the eye; using finger guards; using massages; drinking fluids to relieve heat stress. *Employee is responsible for providing any related doctor抯 notes to supervisor. Supervisor will then forward the notes to Jillian Townsend, Maintenance Building: After receiving medical treatment, all doctor抯 notes must be taken to your supervisor who will then forward to HR for accident pay authorization, if applicable. *Days away from work? If information is available at time of form completion, check yes or no. 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