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Division of Business Affairs
Facilities Management and Environmental Health & Safety (EHS)



Incident/Accident Investigation Form - DA2000 [Word Doc]


Any ULM employee who experiences or witnesses an accident involving personal injury should first determine if the injured person (employee or other) requires assistance.

  1. If the injured person is ambulatory, assist them in reporting directly to the Student Health Center at 1140 University Avenue.
  1. If the injury prevents movement, provide cover or other comfort as appropriate. DO NOT ATTEMPT TO MOVE THE INJURED PERSON. Contact the University Police by dialing 1-911 and give them the details. The University Police will arrange emergency transportation.
  1. Report the mishap to the appropriate official:
  1. Traffic accidents and non-work-related accidents should be reported to the University Police.
  1. Work-related accidents or near-misses/incidents should be reported to the supervisor of the employee(s) involved in the incident.
  1. All other accidents (including visitors) should be reported to the Environmental Health and Safety Office at extension 5177 and University Police.



All employees must report any injury to their supervisor as soon as practical, at least by the end of the shift during which the injury occurred.

First aid kits are available in academic buildings for minors scrapes and cuts.

Minor injuries should also be treated at the Student Health Center and the employee will be returned to work as soon as practical.

In the event of authorized medical treatment, the immediate supervisor will ensure the completion of an "EMPLOYER'S REPORT OF OCCUPATIONAL INJURY/ILLNESS" report form and the "INCIDENT/ACCIDENT INVESTIGATION FORM DA2000 and will forward a copy of each via the Department Head to the Human Resources Office. 

If services of a physician are needed, the employee will be given authorization for treatment at the local treatment center designated by Health Services personnel. With the exception of an emergency situation, off campus treatment may be at the expense of the employee and not subject for compensation payment.

In case of a serious injury where the victim should not be moved except by trained emergency medical personnel, the University Police Dispatcher should be notified by calling 342-5350 and given the details. 

The employee will provide his supervisor with the injury diagnosis and return to work will be by authorization from the attending physician.

Note: ULM does support a back-to-work program so that the injured can return to light duty work if they are not able to return to regular duties.