Harrisfield 15

Accident and Incident reporting on Campus

Prompt Accident and Incident Reporting

Administrative Services needs all LC State departments to report any accident or incident, whether it is for automobile, property or liability to our office within 24 hours, wherever possible and no later than 48 hours. That way, we can take the necessary steps to process any applicable insurance forms to our State Insurance Administrator.

Please do not wait to report an incident or accident until you have all available information or for the receipt of repair or replacement cost estimates on property. Send your report with the available information you have upon your first notice. We can follow up on the needed additional information or property cost estimates after we receive the incident or accident report.

For staff and faculty who have experienced a work-related injury or illness, please follow the procedures on the Human Resources web site, under "Forms" and "Worker's Compensation Notice of Injury."  

Any incidents that involve individuals other than staff or faculty, please follow the guidelines below. 

Accident and Incident Reporting

LC State departments need to report all accidents or incidents, which cause or could cause injury or property damage.

Departments need to complete the Accident Loss Safety Report, below. When complete, hit submit to send it to risk@lcsc.edu.  

Accident, Loss, Safety-Hazard Report

Accident, Loss, Safety-Hazard Report
Do we have consent for storing the submitted data.
What is today's date?
Who is the person reporting the accident?
What is your phone number?
What is the reporter's email address?
Are there any others involved?
What is the date and time of the accident?
Type of Accident What is the type of accident?
Person Involved Persons involved.
What is the location of the accident/loss/safety hazard?
What were the weather conditions at the time of the incident?
Describe what happened?
What is the estimated value?
What is the injured party's name?
What is the injured party's phone number?
What are the injuries?
What is the injured party 's name?
What is the injured party's phone number?
What are the injured party's injuries?
Please list all witness names and phone numbers.
Is there other pertinent information?
Was the accident/loss or safety hazard preventable or unpreventable, in your opinion? Do you think the accident/loss or safety hazard was preventable?
Please explain if you answered yes to the question above.
Were there any other underlying causes?
Please list the potential severity.
What is your recommendation?
What were the actions taken?