Supervisor's Accident Analysis and Prevention Report

Please complete the report within 24 hours of notice of the incident.

Click here to report an incident

If one of your employees sustains a work-related injury or illness, the worker’s compensation program is in place to provide financial coverage for treatment and time lost from employment.

When this occurs, you are responsible for the following.

First things first…

Make sure injured employee seeks medical help if needed. 

Initiate investigation of facts/root causes of accidents and near misses no later than 24 hours after they occur

  • Interview the injured worker and witnesses.
  • Obtain information about the injury to improve work practices and eliminate reoccurrence.
  • Notify and work with campus safety and health professionals as needed for the incident.

Complete and submit the Supervisor’s Accident Analysis and Prevention Report  within 24 hours of notice of the incident.

Be sure to…


  • Work with employee, Worker’s Compensation Coordinator, and occupational safety/health staff
  • assess the potential for modified duties and work restrictions,
  • periodically contact each absent injured worker directly to show concern and discuss recovery progress/return to work

Follow-up the investigation

  • Follow up promptly to identify corrective and preventive action;
  • Review investigation report/proposed action with facility health and safety experts; implement agreed-upon corrective action; and
  • Communicate important investigative findings and solutions as appropriate.


If there’s been a work rule violation:

  • Consult with your Human Resources department regarding steps for employee discipline.

If there’s time lost from work:

  • Remind the injured employee to provide medical documentation regarding any time away from work.
  • Submit time reports and all supporting medical forms to the Worker’s Compensation Coordinator biweekly at a minimum.

If there are job restrictions:

  • Arrange for alternate light duty work assignments for the injured worker and advise Worker’s Compensation Coordinator.
  • Check your campus Return to Work program for additional information.


Throughout the injury/ illness recovery process…

  1. Treat injured employee with dignity and respect.
  2. Maintain contact with the injured employee and the Worker’s Comp Coordinator.
  3. Maintain confidentiality of all information related to claim.