700-03
ACCIDENT REPORTING (EMPLOYEE-VEHICLE-PROPERTY)

Department: SAFETY

Effective Date:    1/1/1987

Supersedes:    6/1/1980

Staff Contact:    M. McDowell

Approved by:    Barbara Y. Shinpoch

1.0 PURPOSE:

To establish procedures for accident reporting.

2.0 ORGANIZATIONS AFFECTED:

All departments/divisions.

3.0 REFERENCES:

Not applicable.

4.0 POLICY:

In an effort to prevent costly accidents, improve ineffective work habits and procedures, provide a picture of accident causes and indications of safety and training deficiencies, all accidents involving injury to City employees or private individuals through some action of the City or damage to City vehicles or property, or damage by City vehicles or employees to private property shall be reported according to the following procedures.

5.0 DEFINITIONS:

Not applicable.

6.0 PROCEDURES:

6.1    Every incident involving injury to employees or private individuals through some action of the City or damage to City property, equipment or vehicles by employees or damage to private property caused by the City will be investigated by the appropriate supervisor. Circumstances and conditions surrounding the incident, assessment of responsibility and recommendations for prevention will be noted.

At the discretion of the supervisor, or upon request of the employee, the Chairman of the Central Safety Committee or the Safety Coordinator may be called to the scene.

6.2    No later than two working days from the date of the incident, the correct reporting forms must be completed and forwarded as specified in the following sub-sections.

6.2.1    Vehicle Accidents

When an incident involves damage to a City vehicle or damage is caused to a private vehicle, the supervisor must complete a City of Renton Vehicle Accident Report (Form #10F-29) and forward it to the Safety Coordinator in the Personnel Department. A Gallagher Bassett, Inc. form, Accident Report, Auto and Truck (Form #G-112R), must also be completed and forwarded to the Claims Coordinator in the Finance Department. Copies of both forms are in envelopes marked “Accident and Property Loss Reporting Procedures,” which are kept in the glove compartment of City vehicles. If an envelope containing the forms is missing from the vehicle, replacements may be obtained from the Finance Department.

6.2.2    Damage to City Property Other Than Vehicles

In the case of loss or damage to City property other than vehicles, the Gallagher Bassett, Inc. form, Loss Report-Property (Form # G-220R), should be completed and forwarded to the Claims Coordinator, Finance Department. This form can also be found in the envelope marked “Accident and Property Loss Reporting Procedures” or may be obtained from the Finance Department.

6.2.3    Bodily Injury to Private Citizens or Damage to Private Property

Bodily injury to someone who is not employed by the City of Renton or who does not serve the City in an official capacity as well as damage caused by the City to private property, except for damage to private vehicles, must be reported on the Gallagher Bassett, Inc. form, Accident Report-General/Product Liability (Form# G-113R), and forwarded to the Claims Coordinator, Finance Department. The form is part of the package in the envelope marked “Accident and Property Loss Reporting Procedures.” Copies may also be obtained from the Finance Department.

6.2.4    Employee Injury

1.    All injuries to employees at work must be investigated and City of Renton form, Supervisor’s Report of Incident (Form# 10F-27), completed by the supervisor for accidents involving general employees. For employees covered by the LEOFF system, another City of Renton form, Supervisor’s Accident/Injury Report-Police and Fire (LEOFF) Personnel (Form# 10F-24), should be used in place of Form # 10F-27. These forms are for internal reporting purposes only and should be submitted for all employee injury incidents whether or not medical care is required. in both cases, the form should be forwarded to the Safety Coordinator in the Personnel Department. Forms are available in department offices and the Personnel Department.

2.    When a non-LEOFF I employee’s on-the-job injury requires the attention of a physician, the physician should be provided with a Washington State Department of Labor and Industries form, Physicians Initial Report, for self-insured employers. The injured employee and his/her supervisor must complete a second Department of Labor and Industries form, Self Insurers Accident Report (Form# SIF-2) and forward it to the Safety Coordinator, Personnel Department. Both forms may be found in envelopes marked “Industrial Injury Claims Package,” which are available in department offices and the Personnel Department.

3.    If an injured employee misses work in addition to the day of injury because of an on-the-job accident, the supervisor must complete Supervisor’s Report, On-the-Job Injury Time Loss Report (Form# 10F-31) forms for the entire period of the employee’s absence. The white copy should be forwarded to the Safety Coordinator, Personnel Department, the yellow copy sent to the Payroll Clerk in the Finance Department, and the pink copy sent to the department payroll clerk. The form is available in department offices and the Personnel Department.

4.    More detailed information on reporting procedures for on-the-job injuries may be found in City of Renton Policy and Procedure number 700-09.

5.    The procedures outlined in sub-section 6.2.4(2) concerning injuries requiring medical attention do not apply to LEOFF I Police and Fire personnel. LEOFF I personnel should obtain medical care through their City medical insurance plan as they would for non-work related injuries and illnesses, but physicians and other providers of medical or related services should be informed that treatment is required because of an on-the-job injury. The provisions of sub-sections 6.2.4(1) and 6.2.4(3) apply to all City employees, including LEOFF I personnel.

6.2.5    Major Accidents

In the case of a major accident resulting in severe injury, death or significant property loss, the City’s insurance claims adjuster, Gallagher Bassett, Inc., should be notified immediately by telephone (455-4054) on a 24-hour per day basis. Severe injury or death should also be reported to the Personnel Department (2556) immediately or, if the accident occurs after normal office hours, at the beginning of the next work day.

6.3    The log of occupational injuries and illnesses required by OSHA/WISHA is maintained in the Personnel Department and is available for inspection upon request.