Lake Superior State University
Lake Superior State University
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Section: Employee/Labor Relations Section Number: 4.2.1
Subject: Accidents/Injuries: Accident and Incident Reporting Date of Present Issue: 10/20/94
  Date of Previous Issues:
05/67, 11/81, 03/87


All accidents and incidents occurring on campus to students, employees, or visitors must be reported. All injuries to employees or student employees must be reported within 24 hours to the Employee Relations Office. All incidents, and all accidents/injuries involving non-employees, should be reported within 24 hours to the risk manager.

Because of the familiarity with the facilities, activities, and operations which were related to the incident, it is advantageous that the report be initiated by the person supervising or responsible for the area in which it occurred. If the supervisor is not available, his/her designated representative, or the security officer on duty should immediately initiate the report. In preparing the report, the facts should be clearly stated, generalities and opinions should be avoided. Information provided may help other departments in preventing similar accidents.


For accidents or Injuries to Employees:
Supervisor, Employee/Witness or Security Office 1. Render first aid as required.

2. Seek professional assistance either on campus or medical facilities available in area. The University has the right to name the treating medical facility or doctor to be used by an employee for the first 10 days. Employees then have the right to treat with any doctor they choose. Employees must, however, notify the University of the intent to treat with another doctor and must provide the name and address of the doctor.

3. Complete and send "Order for Medical Treatment" form with the injured employee. If time does not permit, this form will be mailed to the attending physician or facility within 24 hours. (Form No. 35050, Attachment #1).

4. Complete within 24 hours, "Lake Superior State University First Report of Injury/Accident" (LSSU-234-193, Attachment #2). The Security Office may need to complete an Incident Report as the situation requires, and distribute as indicated on the form.

Office of Employee Relations 5. Establishes and maintains an accident report file and log in accordance with MIOSHA requirements for all work-connected injuries.

6. For all work-connected injuries, submits "Employer's Basic Report of Injury" (Form MDL-1-100, Attachment #3) to Adjusting Services Unlimited before the eighth day following the accident. The form will indicate whether the report is for reporting purposes only, involves medical fees, and/or involves lost time.

7. Reports to Adjusting Services Unlimited the date employee returns to work.

8. Tabulates and posts annual summary of MIOSHA Accident report, as required by law.

For accidents or Injuries to Non-Employees:
Supervisor, Employee/Witness or Security Office 9. Provides first aid or assistance in seeking medical help.

10. Report accident/incident on Form LSSU-234 (Attachment #2), or Incident Report, whichever applies.

Risk Manager 11. Maintains file on all Incident Reports and on injury/accidents to visitors and non-working students, and non-injury accidents.

Note: The above listed forms are available in the Employee Relations Office or the Security Office.


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