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INJURY, ILLNESS, ACCIDENT/INCIDENT, FATALITY AND MOTOR VEHICLE ACCIDENT REPORTING AND INVESTIGATION

DAO 209-3: INJURY, ILLNESS, ACCIDENT, AND FATALITY INVESTIGATION AND REPORTING
Number: DAO 209-3
Effective Date: 2015-07-20

SECTION 1. PURPOSE.

.01       This Order sets forth the Department of Commerce (the Department) policies and requirements for identifying the procedures, forms and electronic systems to be used when reporting and investigating occupational injuries, illnesses, accidents/incidents, fatalities, work-related motor vehicle accident, and major damage to federal property.

.02       This revision:  requires operating units to notify the Occupational Safety and Health Administration (OSHA) of work-related fatalities within eight hours and work-related inpatient hospitalizations of one or more employees, amputations and losses of an eye within 24 hours; updates the fatality and injury reporting procedures and related Form CD-137, “Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality”; allows bureaus not using Form CD-137 to use other electronic reporting systems to document accidents/injuries; requires employees submitting Department of Labor (DOL) Forms CA-1, “Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation” and CA-2, “Notice of Occupational Disease and Claim for Compensation” to utilize DOL’s  Employees’ Compensation Operations and Management Portal (ECOMP); and changes the title of the Order to Injury, Illness, Accident/Incident, Fatality and Motor Vehicle Accident Reporting and Investigation.

SECTION 2. AUTHORITY.

The legal authorities for this Order are:  Title 29 Code of Federal Regulations (CFR) Part 1960, "Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters," which pertain to the reporting and investigation of work-related injuries, illnesses, accident/incidents, and fatalities; Occupational Safety and Health Act of 1970, 29 U.S.C. ‘651 et seq.; Title 29, CFR Part 1904, "Recording and Reporting Occupational Injuries and Illnesses;" Executive Order 12196, "Occupational Safety and Health Programs for Federal Employees;" and Department Administrative Order (DAO) 202-810, "Workers' Compensation for Federal Employees."

SECTION 3. POLICY.

.01       The Department is responsible for providing safe and healthful workplaces and conditions of employment for all employees. 

.02       Prompt reporting and investigation of any work-related injury; illness; accidents/incidents; fatality; motor vehicle accident; or any major damage involving major federal property or equipment and Department employees, contractors, visitors, researchers, or other personnel or property will provide important information for the systematic identification, correction, and prevention of occupational safety and occupational health hazards.

SECTION 4. APPLICABILITY AND SCOPE.

This Order applies to all Department bureaus, agencies, offices, operating units, contractors, and other components.

SECTION 5. DEFINITIONS.

The following definitions, adopted from applicable Department of Labor, Occupational Safety and Health Administration (OSHA) regulations, are relevant to this Order:

a.         Accident/Incident.  A work-related event that resulted in an injury, amputation, loss of eye, illness, fatality, property damage, or a near miss accident/incident that could have resulted in
an injury, illness, fatality, or property damage.

b.         Establishment.  A single location where business is conducted or where services are performed.  Typically, an establishment refers to a field activity, regional office, an area office, installation or facility.

c.         First Aid.  First aid refers to medical attention that is usually administered immediately after the injury and at the location where it occurred.  It often consists of a one-time, short-term treatment and requires little technology or training to administer.  First aid can include cleaning minor cuts, scrapes or scratches; treating a minor burn; applying bandages and dressings; the use of non-prescription medicine; draining blisters; removing debris from the eyes; massage; and drinking fluids to relieve heat stress.

d.         Illness.  An abnormal condition or disorder.  Illnesses include both acute and chronic illnesses and diseases, such as, but not limited to: a skin disease, respiratory disorder, or poisoning.

e.         Injury.  A wound, amputation, loss of eye, or other condition of the body caused by an external force.  The injury must be identifiable as to the time and place of occurrence and member or function of the body affected; and is caused by a specific event or incident or series of events or incidents within a single work day or work shift.  (Note: Injuries are recordable only if they are new, work-related cases that meet one or more of the 29 CFR Part 1904 recording criteria.).

f.          Lost Time Case.  A non-fatal injury that causes any loss of time from work beyond the day or shift on which it occurred or a non-fatal illness that causes loss of time from work.

g.         Lost Work Days.  The number of work days (consecutive or not) during which the employee would have worked but could not because of any occupational injury or illness.  Lost work days include weekends, even if the employee was not scheduled to work.  The day or shift which the injury occurred should not be included in the calculation of lost work days.

h.         Medical Treatment.  Medical treatment means the management and care of a patient to combat a disease, disorder, injury or illness.  For the purposes of 29 CFR 1094, medical treatment does not include visits to a physician or other licensed health care provisional solely for observation or counseling; or the conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (for example, eye drops to dilate pupils); or first-aid treatment.

i.         Motor Vehicle.  Any self-propelled mechanically or electrically powered vehicle designed to be operated principally on a roadway for the transportation of property or passengers.

j.          Motor Vehicle Accident.  Any occurrence involving a Federal Government owned, leased or rented motor vehicle, or privately owned motor vehicle operated on official business, which results in death, injury or property damage, regardless of whom (if anyone) was injured or what property was damaged. 

k.         Near miss.  A near miss describes an incident where no property was damaged and no personal injury sustained, but where a slight shift in time, position, or action, damage and or injury easily could have occurred.  Near misses should be reported so conditions that led to the near miss can be corrected before injury, illness, or property damage occurs.

l.          No Lost Time Case.  A non-fatal accident/incident that does not meet the definition of a lost time case (usually created by a compensation claim for medical expense).  If the employee is injured at 9:00 a.m. and leaves work for the rest of the shift, but returns to full duty the next day, this is considered a No Lost Time Case.

m.        Non-Vehicle Property Damage Accident/Incident.  Any accident/incident, other than motor vehicle, which involves federal real property or federal personal property.  The appropriate Real Property Manager and/or Personal Property Custodian must be informed as soon as practicable of the accident/incident and potential dollar damage.

n.         Occupational Injury or Illness.  Relating to employment, the work environment, and/or places of employment.

o.         OSHA Recordable Injury or Illness.  Any work-related occurrence that results in an injury, amputation, loss of eye or illness to personnel requiring medical treatment or involving lost or restricted work days.  These injuries and illness must be recorded on the OSHA 300 Log.  This definition does not include "first aid treatment," where first aid is immediate and temporary treatment of a victim of sudden illness or injury.

p.         Safety Coordinator/Specialist.  For the purpose of this Order, the Safety Coordinator/ Specialist is the person designated by the head of a bureau, operating unit, or regional center, and assigned the responsibility for implementing the occupational safety and health program within their organization.

SECTION 6. RESPONSIBILITIES.

.01       Employee.  Each federal employee, or someone acting on the employee's behalf, is responsible for the prompt reporting of all accident/incident(s) or illnesses to his/her supervisor as soon as practicable, and should make reasonable efforts to do so prior to the end of the shift during which the incident occurs, or within 24 hours.  In addition, the employee is responsible for using the DOL ECOMP for the:

a.         Completion of items 1 through 15 of Form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation," for each traumatic injury sustained while in the performance of his/her job, if the employee elects to file a workers' compensation claim;

c.         Completion of Form CA-2, "Notice of Occupational Disease and Claim for Compensation," for each occupational illness sustained in the performance of his/her job, if the employee elects to file a workers' compensation claim;

b.         Timely submission of accident/incident information and workers' compensation forms to his/her supervisor; and

d.         Completion of applicable items on Form CD-137 or other electronic reporting systems used by bureaus.

.02       Supervisor.  Each supervisor is responsible for the timely completion and submission of the following:

a.         Form Form CD-137 or other electronic reporting systems used by bureaus for each federal employee involved in the accident/incident or illness.  Once Form CD-137 is completed, it shall be distributed in accordance with Section 7.01 of this Order;

b.         Items 17 through 38 of Form CA-1.  Where appropriate supervisor is also responsible for obtaining witness information for the completion of items 17 through 20; and

c.         Additional reporting requirements and procedures, as appropriate, found in DAO 202-810.

.03       Safety Coordinators/Specialist.  The operating unit Safety Coordinators/Specialist, as appropriate, shall enter Form CD-137 information or other electronic reporting systems used by bureaus on Form OSHA No. 300, "Log of Federal Occupational Injuries and Illnesses."  A copy of Forms CD-137 and OSHA No. 300 shall be provided to the employee and shall also be retained by the Safety Coordinators/Specialist for a period of five years. 

a.         Statements from witnesses or photographs, investigative and other supporting data shall be attached to Form CD-137 or other electronic reporting systems used by bureaus and retained by the preparing Safety Coordinators/Specialist.   In those instances where a claim could be filed against the Department, the Safety Coordinators/Specialist shall send a copy of Form CD-137 and other investigative evidence to the Department's General Litigation Division, Office of the General Counsel, Herbert C. Hoover Building, Room 5890, Washington, DC, 20230, telephone (202) 482-1069, fax (202) 482-5858 as soon as possible after the accident/incident.

b.         All Safety Coordinators/Specialist shall verify the accuracy of each Form CD-137 or other reporting systems used and, where authorized, ensure the timely electronic transmission of accident/incident data.

c.         Safety Coordinators/Specialist shall:

1.         Immediately inform the servicing Security Office and the Department's Office of Occupational Safety and Health (OOSH) of any fatal incidents, or incidents involving serious injury to three or more personnel in a Department-owned or leased facility, vessel, aircraft, or work-related operation or activity.  This applies to federal employees, contractors, associates or visitors; and

2.         Contact the Regional OSHA office within eight hours of learning of the incident of a fatality or within 24 hours of learning of an inpatient hospitalization of one or more employees, an amputation or a loss of an eye.  Such reports can be made by the bureau to the office nearest to the site where the incident occurred, or to OSHA's toll-free central telephone number at (800) 321-6742.  The OOSH director may designate a person to assist in the investigation.

.04       The Office of Occupational Safety and Health within the Department's Office of Human Resources Management, will:

a.         Develop and maintain a management information system for data on accident/incidents, injuries, and illnesses and cost of accident/incidents;

b.         Analyze data and costs of accident/incidents to identify trends; and

c.         Take appropriate action to assist management and Safety Coordinators/Specialist in reducing those trends and preventing accident/incidents and illnesses.

SECTION 7. PROCEDURES.

.01       The Department is required to immediately report accident/incidents of a significant nature to OSHA.  If appropriate, such reports can be made by the bureau to the Regional OSHA office nearest to the site where the incident occurred, or to OSHA’s toll-free central telephone number
(800) 321-6742.

.02       In addition, accident/incidents of a significant nature must be reported immediately to OOSH at (202) 482-4935.  Significant incidents include the death of one or more employees or the inpatient hospitalization of three or more employees, an amputation or loss of an eye.  In addition to federal employees, this reporting requirement also applies to visitors, contractors, or personnel on the premises who become injured. The Department or bureau official responsible for the injured  personnel or damaged property shall report the following incidents by the quickest method available to their bureau Safety Coordinator/Specialist who shall inform OOSH immediately.  The OOSH Director may designate a person to assist in the investigation of:

a.         An occupational accident/incident, which is fatal to one or more employees, contractors, visitors, or other personnel on the premises;

b.         An occupational accident/incident, which results in the inpatient hospitalization of one or more employees, contractors, visitors, or other personnel on the premises; and

c.         An occupational accident/incident, which results in an amputation or loss of an eye or;

d.         An occupational accident/incident, which involves property damage of $100,000 or more.

.03       The details surrounding the incident shall be recorded on Form CD-137 or other reporting systems used and shall include, at a minimum:

a.         Date, time, and specific location of the accident/incident;

b.         A description of the accident/incident;

c.         Names and other identifier information of all persons (i.e., employee, contractor, visitor, researcher, etc.) involved, and if they were injured, not injured, or died;

d.         Number of fatalities;

e.         Number and extent of injuries/illnesses;

f.          Extent of damage to property, listing whether the property was Departmental property or other property.  Describe other property as clearly as possible; and

g.         Any other information necessary for the completion of Form CD-137 or other reporting systems used .

.04       Accident/incidents not immediately reportable, but which result in death within 6 months of the date of the accident/incident, shall be reported to the appropriate Safety Coordinator/Specialist within 24 hours from the time the supervisor or other responsible official becomes aware of the death.  The Safety Coordinator/Specialist will report the death to OOSH within 24 hours of becoming aware of the death.

.05       Accident/incidents involving damage to property shall be reported on Form CD-52, "Report of Review of Property" and may be submitted electronically or by hardcopy.

SECTION 8. FORMS.

The following forms are required to report work-related accident/incident, injury, and illness, motor vehicle accident or damage (government vehicles and personnel vehicles being used for government business), and real or personal property/equipment damage:

a.         Form CD-137 or other electronic reporting systems used by bureaus shall be completed by the supervisor within five working days of the incident and copies distributed as follows:

1.         One copy to the employee;

2.         One copy to the employee's supervisor; and

3.         One copy to the Safety Coordinator/Specialist.

b.         Form SF-91, "Motor Vehicle Accident Report," and, where appropriate, Form SF-94, "Statement of Witness," may be used to record witness identity and accident/incident information, but shall not be used in place of Form CD-137 or other electronic reporting systems used by bureaus.

c.         Department of Labor Form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation," or Department of Labor Form CA-2, "Notice of Occupational Disease and Claim for Compensation."

d.         Form CD-52 shall be used to report damage to property.

SECTION 9. EFFECT ON OTHER ORDERS.

.01   This Order supersedes Department Administrative Order 209-3, dated December 7, 2004.

.02   Nothing in this Order shall have the effect of or be construed as an exception to the investigative authorities and responsibilities of the Inspector General under Department Organizational Order (DOO) 10-13, “Inspector General,” August 31, 2006.

Signed by: Director for Human Resources Management

Approved by: Chief Financial Officer and Assistant Secretary for Administration

Office of Primary Interest: Office of Human Resources Management

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Page last updated:August 29, 2011