{"id":873,"date":"2025-04-10T14:03:15","date_gmt":"2025-04-10T21:03:15","guid":{"rendered":"https:\/\/cas.wsu.edu\/safety\/?page_id=873"},"modified":"2025-04-10T14:22:56","modified_gmt":"2025-04-10T21:22:56","slug":"form-incident-reporting-flowchart","status":"publish","type":"page","link":"https:\/\/cas.wsu.edu\/safety\/form-incident-reporting-flowchart\/","title":{"rendered":"Form &#8211; Incident Reporting Flowchart"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Incident Reporting Flowchart<\/h1>\n\n\n<div class=\"wsu-row wsu-row--sidebar-right\" >\r\n    \n<div class=\"wsu-column\"  style=\"\">\r\n\t\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/safety\/wp-json\/wp\/v2\/pages\/873#gf_1' >\n                        <div class='gform_body gform-body'><div id='gform_page_1_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_1_4\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_4\"><legend class='gfield_label'  >Are emergency services required?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_4'>\n\t\t\t<div class='gchoice gchoice_1_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Yes'  id='choice_1_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_4_0' id='label_1_4_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='No'  id='choice_1_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_4_1' id='label_1_4_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_5' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_18\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><h2>Incident Reporting<\/h2><\/div><div id=\"field_1_28\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_28\"><ol style=\"font-size: 1.2rem;padding-bottom:0\">\n<li>Call 911 to reach emergency services at WSU Pullman.<\/li>\n<li>If an employee sustained serious injury, immediately report the injury to EH&#038;S at 509-335-5251.<\/li>\n<li>Once Pullman Fire or WSU Police arrive, they will take command of the incident.<\/li>\n<li>Notify the injured person&#8217;s supervisor, if applicable.<\/li>\n<\/ol><\/div><div id=\"field_1_8\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_8\"><hr style=\"margin: 0\">\n<br \/>\n<p>If you have not yet <a href=\"http:\/\/ihr.hrs.wsu.edu\/forms\/incident_report.aspx\" target=\"_blank\"><b>submitted an online Incident Report<\/b><\/a>, please do so as close to the time of the incident as possible. Incident Reports have a 24-hour deadline.<\/p>\n\n<p><i>Anyone can submit an Incident Report on behalf of someone else, and anyone can submit an Incident Report on their own behalf. <b>For WSU employees, however, an Incident Report is preferably submitted by the injured person\u2019s supervisor<\/b>. Once submitted, a copy of the Incident Report is electronically forwarded to the supervisor, EH&#038;S, and HRS for documentation and follow-up.<\/i><\/p>\n\n<p>Forward the emailed copy of the Incident Report you receive to your unit chair or director, your unit\u2019s safety committee chair, and the College of Arts and Sciences safety committee chair.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_10' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_10' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_1_26\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_26\"><h2>Supervisor&#8217;s Accident Investigation Reporting<\/h2><\/div><fieldset id=\"field_1_11\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><legend class='gfield_label'  >Did the incident involve a WSU employee?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_11'>\n\t\t\t<div class='gchoice gchoice_1_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Yes'  id='choice_1_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No'  id='choice_1_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_17\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><legend class='gfield_label'  >Did the employee sustain serious injury?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_17'>Serious injury includes:\n<ul style=\"padding-bottom:0px\">\n<li style=\"padding-bottom:0px\">Death<\/li>\n<li style=\"padding-bottom:0px\">Hospitalization (given a bed for an overnight stay)<\/li>\n<li style=\"padding-bottom:0px\">Amputation (to include partial loss of fingers\/toes)<\/li>\n<li style=\"padding-bottom:0px\">Loss of an eye<\/li>\n<\/ul><\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_17'>\n\t\t\t<div class='gchoice gchoice_1_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_1_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_17\"   \/>\n\t\t\t\t\t<label for='choice_1_17_0' id='label_1_17_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_1_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_17_1' id='label_1_17_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_21\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><legend class='gfield_label'  >Did the employee receive medical attention?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_21'>\n\t\t\t<div class='gchoice gchoice_1_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_1_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_0' id='label_1_21_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_1_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_21_1' id='label_1_21_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_19\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><legend class='gfield_label'  >Was the employee unable to work the next full or subsequent shift(s) as a result of the injury or illness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_19'>\n\t\t\t<div class='gchoice gchoice_1_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_1_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_19_0' id='label_1_19_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_1_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_20\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><legend class='gfield_label'  >Was the incident a near-miss?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_20'>A near-miss incident occurs when events and conditions exist where injury or illness would have been serious. <\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_20'>\n\t\t\t<div class='gchoice gchoice_1_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_1_20_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_20\"   \/>\n\t\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_1_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_22\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><hr \/>\n<ul style=\"margin-top: 1rem; padding-bottom: 0\">\n<li style=\"font-size: 1.2rem; list-style-type: none; padding-bottom: 0\"><b>Immediately contact EH&#038;S at <a href=\"tel:5093355251\">509-335-5251<\/b><\/a><\/li>\n<\/ul><\/div><div id=\"field_1_24\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><hr style=\"margin-top: 0\" \/>\n<ol>\n<li style=\"font-size:1.2rem;padding-bottom: 1rem\">Supervisor must complete and submit a <a href=\"https:\/\/policies.wsu.edu\/prf\/documents\/2017\/10\/2-26-supervisors-accident-investigation-report.pdf\/\" target=\"_blank\"><b>Supervisor\u2019s Accident Investigation Report<\/b><\/a>. 48-hour deadline. Submit report to EH&#038;S at sringo@wsu.edu.<\/li>\n<li style=\"font-size:1.2rem\"><p>Forward a copy of the Supervisor\u2019s Accident Investigation Report to unit chair or director, unit safety committee chair, and CAS safety committee chair.<\/p>\n<p>Provide the unit and college safety committees, EH&#038;S and HRS with information as requested.<\/p>\n<\/li>\n<ul>\n<\/ol><\/div><div id=\"field_1_25\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><hr>\n<p style=\"font-size: 1.2rem\">Supervisor&#8217;s Accident  Investigation Report is not required. Provide the unit and college  safety committees, EH&#038;S and HRS with information as requested.<\/p><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='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' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <p style=\"display: none !important;\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"213\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div>\n<\/div>\r\n\n\n<div class=\"wsu-column\"  style=\"\">\r\n\t<\/div>\r\n\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Incident Reporting Flowchart<\/p>\n","protected":false},"author":45,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"categories":[],"tags":[],"wsuwp_university_location":[],"wsuwp_university_org":[],"_links":{"self":[{"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/pages\/873"}],"collection":[{"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/users\/45"}],"replies":[{"embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/comments?post=873"}],"version-history":[{"count":2,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/pages\/873\/revisions"}],"predecessor-version":[{"id":879,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/pages\/873\/revisions\/879"}],"wp:attachment":[{"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/media?parent=873"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/categories?post=873"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/tags?post=873"},{"taxonomy":"wsuwp_university_location","embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/wsuwp_university_location?post=873"},{"taxonomy":"wsuwp_university_org","embeddable":true,"href":"https:\/\/cas.wsu.edu\/safety\/wp-json\/wp\/v2\/wsuwp_university_org?post=873"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}