TITLE: Injury & Accident Reporting
REVISED: January 1, 2018

Evergreen Estates is committed to providing a safe work environment to its employees.

Employees are required to inform their supervisor or Administrator of any work-related injury they receive while performing their assigned job duties IMMEDIATELY. Employee may inform their supervisor in person or by phone.

REPORTING PROCESS

An employee involved in a work -related incident that results in an injury will report the incident and injury to their supervisor or Administrator IMMEDIATELY. If the employee or supervisor feels the injury requires immediate treatment, the employee will be directed to the Emergency Room of Tri-State Hospital.

If the employee is not able to contact their supervisor or Administrator due to the nature of the injury or illness, then another employee will contact their supervisor or Administrator and report the incident.

The employee is required to report the injury IMMEDIATELY; however, the employee will meet with the Administrator within 3 business days to finalize the necessary paperwork (OSHA 301 & 300) needed for the processing of the claim. If the employee fails to assist in completing the necessary paperwork, the claim will still be filed on their behalf and the employee will be disciplined, to include termination.

• OSHA 301 is given to the employee and aa copy is filed in the employees file
• OSHA 300 is kept with our financial records

It is the policy of Evergreen Estates to have all employees who report being involved in a work-related injury to be drug tested in accordance with our Drug Free Workplace Policy. Work-related injury is considered to have occurred when an incident is reported to the Administrator for recording onto the required OSHA logs.

If the injury requires any medical follow-up(s) by their physician, the employee is not permitted to cancel or reschedule these medical appointments. Cancelling or rescheduling follow-up medical appointments may be grounds for disciplinary action up to and including termination.

An employee who has been treated by a healthcare professional for a work-related injury will be required to have a signed work release by their physician to full duty, before they are permitted to return to their previously assigned work duties and schedule.

Evergreen Estates considers making false written and/or verbal statements concerning an injury – A FRAUD. Evergreen may pursue legal actions toward any employee who may have attempted to commit fraud against the facility by filing a false claim

INCIDENT INVESTIGATION

If an employee dies while working or is not expected to survive, or if any employee is in-patient hospitalized as a result of a work-related incident, the Administrator will contact the Department of Labor and Industries within 8 hours after becoming aware of the incident. During weekends and evenings, the toll -free notification number is: 1-800-321-6742. At a minimum, the following must be provided:

• Employees name and other employees involved
• Location and time of the incident
• Extent of injuries or illness
• Brief description of what happened

DO NOT DISTURB the scene except to aid in rescue or make the scene safe.

A preliminary investigation will be conducted by the Administrator and any other person designated by the Director to help in the investigation.

• Take written statements from witnesses
• Photograph the incident scene and equipment involved
• Document the condition of equipment involved and any anything else in the work area that may be relevant.
• Document the sequence of events leading up to the incident, conclusions about the incident and any recommendations to prevent a similar incident in the future.
• The report will be reviewed by the safety committee at its next regularly scheduled meeting.

When a supervisor becomes aware of an employee injury where the injury was not serious enough to warrant a team investigation as described above, the supervisor may be requested to write a statement concerned incident.

Failure to comply with this policy will result in disciplinary action, up to and including termination of employment