Texas Tech University System Incident Reporting
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2USO Guide Appendix R
ODS Safety Services
Incident Reporting
Aug 2009
Updated
Non-Employee
Employee
SUPERVISOR COMPLETES
Conscious
Unconscious
First Report of
Injury/Illness/Accident
ASK “Do you need to
(OP 70.13a)
go to the Emergency
SUPERVISOR COMPLETES
Room?”
Supervisor’s Investigation of
Employee’s Accident/Incident
(OP 70.13f)
Call 9-911 for
No
Yes
medical
EMPLOYEE COMPLETES
assistance
Employee’s Report of Injury
(OP 70.13b)
Call TTU Police
Dept.
EMPLOYEE COMPLETES
Authorization for Release of
Information
(OP 70.13c)
Call Safety
Services
EMPLOYEE COMPLETES
Employee’s Election Form
Non-Clinical Area
Clinical Area
(OP 70.13e)
Non-Employee
Occurrence
Witness Statement
Incident/ Injury
Report
[if any]
(OP 70.13d)
Report
[clinical area]
[non-clinical area]
(SOM Policy 8.02)
(OP 75.14b)
Infection Control/
Employee Health
Witness Statement
(exposures)
[if any] (OP 75.14c)
Infection Control/
Safety Services
Employee Health
(sharps injuries)
EMPLOYEE COMPLETES
General Counsel-Risk Mgt.
(possible legal issues)
TDH Form E59-10666
Director of Student Services
(student involvement)
Infection Control/Employee Health
(exposures)
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