Supervisor Incident Protocol

Home / Campus / Workers Compensation ( Published on 2014-09-17 )

An "Incident" is:

  • A near miss (but no exposure, injury or illness occurs), or
  • An exposure to a hazardous substance (but no injury or illness occurs), or
  • An injury or illness

When a near miss or exposure occurs at work:

  1. Immediately fill out the Supervisor Incident Report (SIR) form:
    1. Fax it to HR Disability Management Services (DMS) at fax number: 415/476-2328 or
    2. Email it to your DMS representative (using "Secure:" in the subject line of the email)

For exposure to body fluids or blood advise the employee to call:

  1. UCSF hotline: beeper # (415) 353-7842 or (415) 353-STIC
  2. SFGH hotline: SFGH Hotline is (415) 469-4411

The employee should follow all established infection control and medical center protocols. Workers' compensation is a separate process.

For exposure to other hazardous substances call:

Environmental Health & Safety (EH&S): 415/476-1300.

When an injury or illness occurs at work:

Upon knowledge of injury or illness there are three (3) immediate actions a supervisor must take:

Immediately:

  1. Refer the employee to UCSF's Designated Medical Provider (see below).
  2. Remove, tag, and store any broken equipment that caused injury, and contact EH&S.
  3. Fill out the Supervisor Incident Report form:
    1. Fax it to HR DMS at fax number: 415/476-2328, or
    2. Email it to your DMS representative (using "Secure:" in the subject line of the email)

Detailed procedure for Injury or Illness:

  1. A) Emergency (serious injury)
    1. Escort the employee to the nearest emergency medical care facility.
    2. Call an ambulance if necessary.
    3. For follow-up care, refer the employee to one of our designated occupational medicine providers:
      • Occupational Health Services: 415/885-7580, 2330 Post St., Suite 460, San Francisco, CA, 94115.
      • St. Francis Memorial Health Center at SBC Park: 415/972-2249, 24 Willie Mays Plaza, San Francisco, CA, 94107.
      • Kaiser On The Job, 601 Van Ness Ave., Suite 2008, Opera Plaza, Mezzanine Level, San Francisco, CA. 415/833-9600.
    4. Call Disability Management Services at 415/476-2621 as soon as possible to report all Serious or Fatal injuries by phone.

B. Acute care (non-emergency)

  1. Advise the employee to call one of our designated occupational medicine providers:
  • Occupational Health Services: 415/885-7580
  • St. Francis Memorial Health Center at SBC: 415/972-2249 or
  • Kaiser On The Job: 415/833-9600 for a medical appointment
  1. If injury occurs after clinic hours, refer the employee to Long Emergency Department.

 

  1. Remove and store any broken equipment that caused injury.
  • Do not discard equipment or furnishings that have caused injury:
    • Remove the equipment from service.
    • Tag the equipment for identification.
    • Call Environmental Health & Safety at (415) 476-1300 for inspection.
  1. If the employee loses time from work due to injury or illness.
    • Notify your HR Generalist that he or she may need to initiate Family Medical Leave procedures.
  2. Provide Transitional (Modified) Work
    • Make every effort to reduce lost workdays by providing medically appropriate modified work during the transitional stages of your employee's medical recovery.
    • Call Disability Management Services at 415/476-2621 for assistance and consultation in designing transitional/modified work.
    • The day your employee returns to work, call: Sedgwick CMS at 510/302-3180, to prevent overpayment of disability benefits.

By taking the above actions, campus supervisor will:

  1. Prevent future injuries by maintaining a safe work environment.
  2. Minimize the severity of any injury or illness that occurs.
  3. Avoid legal fines and penalties being assessed against their departments.
  4. Minimize financial loss to the employee, the department, and the University as a whole.