THE UNIVERSITY OF RHODE ISLAND
WORK-RELATED INJURY/INCIDENT PROCEDURE
Revised: 02/23/2006
For more information or questions, please contact
Karen Mancini 874-2687
or
Pamela Sherman 874-9054
Fax #: 401/ 874-5530
PURPOSE:
- To identify and help prevent employee incident and injuries.
- To facilitate the processing of Workers' Compensation benefits.
- To ensure thorough reporting and investigation of employee incidents and injuries.
- To help managers facilitate employee's recovery from work-related injuries.
POLICIES:
Employees will be provided a safe and healthy work environment. Employees who are injured on the job will receive assessment and treatment, if appropriate, in order to ensure recovery and a prompt return to work. Workers' Compensation benefits will be provided in accordance with Rhode Island Law. This will be accomplished by:
- Affirmative efforts of the University's managers to prevent employee injuries.
- Prompt diagnosis and treatment of work-related illnesses and injuries.
- Timely submission and analysis of accident/incident reports.
- Injured employees will in most instances report to the designated health care facility for the initial evaluation.
- Employees may elect to receive treatment from the physician of their choice.
Any incident or injury to employees must be reported on the URI Incident/Injury Report Form (USP-14A) immediately following the incident. All injuries, no matter how minor, must be reported. The employee is responsible for initiating the process and must notify his/her immediate supervisor of the incident. The supervisor and the department manager are responsible for completing and monitoring the incident reporting process.
PROCEDURE:
Employee Responsibility:
ACTION:
- Employee reports incident to immediate supervisor and then to department manager, and completes Employee Report section of the URI INCIDENT/INJURY REPORT FORM (USP-14A). When form is completed and signed, the employee gives it to the supervisor for completion.
- If treatment is needed, or an examination is desired by the employee (see *NOTE below) report to the designated treatment facility (if unable to drive, transportation will be provided by the University).
Employee presents GOLD copy of the incident form to designated treatment facility.
Kingston and Bay Campus- Employees report to South County Hospital.
W. Alton Jones - Employees report to nearest medical treatment facility.
Providence Campus - Employees report to Corporate Care at St. Joseph's Hospital.
Department Manager Responsibility:
ACTION:
- Completes Manager's section of URI Incident/Injury Report Form detail, and signs. Ensures all information in Employee Report section is provided, and indicates whether employee had lost time from work
The Department of Labor and Training requires that a copy of the report be received in their office within 10 days of an incident. Therefore, the department must send completed URI Incident/Injury Report to Human Resources promptly. Failure to do so may result in a $250 fine which will be charged to the department.
If injury requires an examination, or if employee desires an examination, send employee to designated treatment facility with the GOLD copy of the completed URI Incident Report form. The WHITE & YELLOW copies are sent to HRA / Benefits within 24 hours of the incident.
If no examination is to be done, forwards completed Incident Report form to the Human Resource Administration / Benefits, Room 21, 80 Lower College Rd., Kingston before the end of the shift on which the incident was reported.
If an employee has suffered a serious injury, he/she should be taken directly to the nearest emergency health care facility. All paperwork should be completed as soon as possible thereafter.
Human Resources / Benefits Responsibility
ACTION:
- Date stamps and reviews URI Incident Report for completeness and ascertains whether further information is required. Forms found to be incomplete will be returned to the department.
- Completes First Report of Injury Form and processes compensation claim. Sends completed report to Division of Workers' Compensation.
Risk Management Officer Responsibility
ACTION:
- Investigates work-related illnesses or injuries concurrently with the submission of the manager's report of injury. Collects information about incidents involving lost time, interview any witnesses, recommends action to prevent recurrence.
*NOTE:
Medical documentation must be provided when an injury involves first aid, medical treatment, musculoskeletal symptoms, or when the employee's duties must be altered or restricted.
FORMS
24 Hour Notification Form
Sick Leave/Payroll Discharge Form
Employees Certificate of Dependency Status
Authorization for Release of Confidential Information
W-9 (for Internal and student workers only)
URI Injury/Incident Report
The URI Incident/Injury Report (USP-14A) is a carbonless form and must be obtained by calling
874-9054
