Forms available in this Section
ULM Safety Manual - Table of Contents



Accidents / Incidents do not just happen, they are caused either by an unsafe act and/or an unsafe condition or a combination of the two. In some cases the person performing the unsafe act does not realize just how serious the consequences can be. In most cases, an unsafe condition or improper use of a tool is the cause of an accident.

Investigations of accidents and incident are necessary, not to set blame but to primarily determine the cause or causes and to do everything within reason to preclude the same thing from happening again. Incidents which could develop into an accident are part of the investigation scheme to prevent such occurrence.

An accident investigation must be conducted for any incident/accident. The report must include information on the person injured, a complete description of the incident/accident, a statement of what caused or might have caused the incident/accident and any corrective action that has been taken or that should have been taken to prevent recurrence.

Before actually beginning an investigation of a work-related accident or incident, the supervisor/ investigator should be thoroughly familiar with "EMPLOYEE REPORT OF INJURY/ ILLNESS" form and the "INCIDENT/ACCIDENT INVESTIGATION FORM DA 2000" (both forms are available at the Human Resources Office). If the accident or incident involves a student, visitor, or client, then the VISITOR/CLIENT ACCIDENT REPORTING FORM DA3000 needs to be completed. After affirming that all necessary and appropriate steps have been taken to provide medical assistance to the injured, the supervisor will complete the following steps in investigating the accident:

  1. Survey the accident scene for information. Gather or note any objects that might have contributed to the accident. Take whatever interim action is needed to prevent recurrence of the incident until permanent action can be formulated and implemented. It is the responsibility of the supervisor to recommend and initiate corrective action. Consult the Environmental Health and Safety Office if necessary. Include a description of the of the individual injured, a description of the incident/accident (bodily injury vs. property damage), a statement of what caused or might have caused the incident accident.
  1. Check the property/ building area for damage and note specific locations such as "the third floor southwest corridor of the Administration building outside room 3-91 on the left side of the corridor".  Be as specific as possible.  Take pictures where ever possible and attached to the report form. Check equipment being used (computer, lawn mower, copier, power tool, etc.) to determine if the equipment if functioning properly.  If there is any question about the equipment, take it out of service until it can be assured the equipment is safe.  Please include any state tag identification numbers, serial number, model, and manufacturer from the equipment in the inspection report.
  1. Get names, addresses and phone numbers of all witnesses. Witnesses, including the person or persons involved, if they are physically capable, should be asked to give a written statement. If not, take an oral statement from them. Statements should provide a description of what happened; what activity was taking place; what tools, if any were in use and any other contributing factors. Witness(es) should be informed that the investigation is intended primarily to determine the cause or causes to determine corrective action and not to place blame.
  1. Complete "EMPLOYEE REPORT OF INJURY/ILLNESS" form and the "INCIDENT/ACCIDENT INVESTIGATION FORM DA2000" if the incident/ accident involves an employee and the VISITOR/CLIENT ACCIDENT REPORTING FORM DA3000 if the incident involves a student, visitor, or client. Promptly forward it to the Safety Office and the Human Resources Office. The Environmental Health and Safety Officer will review the form for accuracy and completeness.
  1. Repeat accident patterns, whether by persons or circumstance should be noted, investigations, and corrective actions identified.

      Same Individual: Employee slipped and fell at the same location a week ago

      Same Operation: Another worker was involved in an accident performing the same operation several days ago.

As result of the investigation, the supervisor/investigator should be able to state: how the accident occurred; if an unsafe act and/or condition was a factor in the accident; what interim actions have been taken to avoid recurrence; if any permanent action is necessary and a recommendation for any future action such as training, changes to procedures and/or environmental factors.

An accident is an occurrence that results in an injury or property damage. For employees, all personal injuries should have a DA2000 "Incident/Accident Investigation Form" and "LDOL Employer's Report of Injury" completed. For non-employees a DA3000 form must be completed.

An incident is an occurrence that could have resulted in an injury or property damage; or could have had an effect on implementation on the safety programs, policies and procedures. All incidents shall be reported using either the DA2000 form (for employees) or the DA3000 form (students, visitors, clients, etc.).

Forms available for download in this Section:
Form Name File types available
Employer Report of Injury/Illness LDOD-WC-1007 PDF File
Incident/Accident Investigation Form - DA2000 PDF File
Student/Visitor/Client Accident Reporting Form - DA3000 PDF File
Incident/Accident Investigation Form - DA2000 Doc
Student/Visitor/Client Accident Reporting Form - DA3000 Doc

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