FOREST SERVICE HANDBOOK MARK TWAIN NF (REGION 9) ROLLA, MO

6709.12-2003-2

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FOREST SERVICE HANDBOOK

MARK TWAIN NF (REGION 9)

ROLLA, MO

FSH 6709.12 – SAFETY AND HEALTH PROGRAM HANDBOOK

CHAPTER 32

– ACCIDENT NOTIFICATION

Supplement No.: R9 Mark Twain 6709.12-2003-2

Effective Date: February 5, 2003

Duration: This supplement is effective until superseded or removed.

Approved: RONNIE RAUM

Forest Supervisor

Date Approved: 02/05/2003

Posting Instructions: Supplements are numbered consecutively by Handbook number and calendar year. Post by document; remove the entire document and replace it with this supplement. Retain this transmittal as the first page(s) of this document.

R9 Mark Twain 6709.12-2003-2 16 Pages New Document

Superseded Document(s)

(Supplement Number and

Effective Date)

MTNF Supplement 96-1 8 Pages

Digest: In order by code, summarize the main additions, revisions, or removal of direction incorporated in this supplement.

6709.12 – Updates required notification, forms, and processes based on type of event and severity of event.

It is my decision to not obtain public involvement in this manual supplement because the subject matter is exempt according to 36 CFR 216.3.

R9 MARK TWAIN SUPPLEMENT

EFFECTIVE DATE: 02/05/2003

DURATION: Effective until superseded or removed

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CHAPTER 32 - ACCIDENT NOTIFICATION

32

– ACCIDENT NOTIFICATION

32.1

– Notification Criteria and Process.

Required notifications, based on event severity, are set forth in exhibits 1-7.




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Exhibit 1

MOTOR VEHICLE ACCIDENTS

Line Officers and Staff Officers at every organizational level are responsible for implementing the Forest Service Safety and Health Program. Further, we must all take personal responsibility for our own safety and the safety of those around us. No job is so important that we cannot take the time to work safely.

Accidents that occur on a district unit will be documented by that unit. If an accident involves an employee in transit, it is the responsibility of the employee’s home unit or staff area to initiate and complete the appropriate documentation.

The Forest Supervisor reserves the right to conduct an investigation into any motor vehicle accident involving an employee on the Mark Twain National Forest if that employee was on duty at the time of the accident.

Accidents under $350.00:

Notification of Incident:

A.

Immediate Supervisor (immediately)

B.

Unit Safety Officer (within 1 working day)

C.

Unit Manager (District Ranger or Staff Officer) (within 2 working days)

D.

Forest Safety Officer (within 3 working days)

Information package will be sent to the Forest Supervisor/Deputy Forest Supervisor within 10 working days. Forest Safety Officer will log accident and route package.

A. Information package will include:

1.

SF-91 Motor Vehicle Accident Report.

2.

AD-112 Report of Unserviceable, Lost, or Damaged Property.

3.

Transmittal letter from Unit Manager (District Ranger or Forest Staff Officer) to

Forest Supervisor/Deputy Forest Supervisor with the package. A recommendation as to employee’s accountability or responsibility for damages will be included.

B. Information package will be routed to the following for information.

1.

Property Management Officer

2.

Public Affairs Staff Officer

3.

Fleet Manager

4.

Forest Supervisory Law Enforcement Officer

5.

Forest Personnel Specialist

6.

Supervisor Office Files




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Accident $350.00 to $1,000.00:

These are “chargeable” motor vehicle accidents. See FSH

6709.12 for the definition of chargeable motor vehicle accidents.


A.


B.


C.

Unit Manager (District Ranger or Staff Officer) (within 1 working day)

D.


E.

Forest Supervisor/Deputy Forest Supervisor (within 3 working days)



1.

SF-91 Motor Vehicle Accident Report

2.

Law enforcement/ police report from appropriate jurisdiction.

3.

AD-112 Report of Unserviceable, Lost, or Damaged Property

4.

SF-94 Statement of Witness (one each per witness, if any)

5.

Photographs

6.

Repair Estimates (minimum of 2)

7.

AD-872 Property Damage Report (as appropriate)

8.

CA-1 or CA-6 (if injury or fatality of FS personnel)

9.

SF-95 Claim for Damage, Injury or Death (as appropriate)

10.


Forest Supervisor/Deputy Forest Supervisor with the package. A recommendation as to employee accountability or responsibility for damages will be included.

B. Information package will be routed to the following for information.

1.


2.


3.

Fleet Manager

4.


5.


6.


Accidents over $1,000.00:


A.


B.


C.

District Ranger of Acting (within 1 working day)

D.

Forest Safety Officer (within 1 working day)

E.

Forest Supervisor/Deputy Forest Supervisor (within 1 working day)

F.

Regional Safety Officer (by Forest Safety Officer) (within 2 working days)




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Information package will be sent to the Forest Supervisor/Deputy Forest Supervisor within 10 working days. Forest Safety Officer will log and route package.


1.

Same as accident $350.00 to $1000.00

2.

Accident review by Unit Manager (District Ranger or Staff Officer) or their designee.

3. Transmittal letter from Unit Manager (District Ranger or Forest Staff Officer) to

Forest Supervisor/Deputy Forest Supervisor with the package. A recommendation as to employee accountability or responsibility for damages will be included.

B. Information package will be distributed to the following:

1.


2. Public Affairs Staff Officer

3.

Fleet Manager

4.


5.


6.


Accidents involving vehicle rollover: All accidents that result in a rollover event are considered reportable accidents. This includes dozers, wheeled tractors, trail groomers, ATVs, etc.


A.


B.


C.


D.


E.


F.

Forest Supervisor or Deputy Forest Supervisor (within 3 working days)

Information will be sent to the Forest Supervisor/Deputy Forest Supervisor within 10 working days. Forest Safety Officer will log accident and route package.


1.

SF-91 Motor Vehicle Accident Report

2.

Law enforcement/ police report from appropriate jurisdiction.

3.


4.

Accident review by Unit Manager (District Ranger or Forest Staff Officer) or their designee.

5.

SF-94 Statement of Witness (one each per witness, if any)

6.

Photographs

7.

Repair Estimates (minimum of 2)

8.

AD-872 Property Damage Report (as appropriate)

9.

CA-1 or CA-6 (if injury or fatality of FS personnel)

10.

SF-95 Claim for Damage, Injury or Death (as appropriate)




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11.

Transmittal letter from Unit Manager (District Ranger or Staff Officer) to Forest

Supervisor/Deputy Forest Supervisor with the package. A recommendation as to employee accountability or responsibility for damages will be included.

B. Information package will be routed to the following for information:

1.


2.


3.

Forest Fleet Manager

4.

Forest Supervisor Law Enforcement Officer

5.


6.





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Exhibit 2

PROPERTY DAMAGE ACCIDENT

A property damage accident is an accident that occurs during Forest Service activity and results in a combined total of $350 or more damage to Government or private property. This also includes damage to properly or legally parked vehicles, or accidents resulting solely from natural causes with no human intervention.


A.


B.


C.

Unit Manager (District Ranger or Forest Staff Officer) (within 2 working days)

D.


E.




1.


2.

AD-872 Property Damage Report

3.

Accident review by Unit Manager (District Ranger or Staff Officer) or their designee.

If private property is involved, an investigation must be conducted by a Law

Enforcement Officer.

B. Information package will be routed to the following for information:

1.


2.

Forest Public Affairs Staff Officer

3.

Fleet Manager

4.


5.

Forest Personnel Officer

6.


NOTE: All property damage accidents are to be investigated, regardless of dollar value. It is appropriate to use any of the forms listed under Motor Vehicle Accidents and Property Damage

Accidents to assist in creating documentation of any accident – and you are encouraged to do so.




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Exhibit 3

INJURY/ILLNESS

TRAUMATIC INJURY

– A wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable by time and place of occurrence and body part affected within a single day or work shift. (CA-1)

OCCUPATIONAL DISEASE/ILLNESS – A condition produced in the work environment over a period longer than one workday or shift, ie; systemic infection, repeated stress or strain, exposure to toxins, poisons, fumes, dust or smoke. (CA-2)

Minor Injury: - NO lost time (COP) or medical expense.


A.


B.


C.

OWCP Coordinator (within 2 working days)

D.


Forms needed by OWCP Coordinator:

Injury – CA-1 Completed and submitted within 10 days of injury.

RECEIPT OF NOTICE OF INJURY must be completed by the

Supervisor and given back to the employee.

Minor Injury: - NO lost time (COP) with medical expense.


A.


B.


C.


D.


Information should be packaged as follows:

A. Forms needed by OWCP Coordinator, with copy sent to the Forest Safety Officer:

1. Injury – CA-1 Completed and submitted within 10 days of injury.


Supervisor and given back to the employee.

2. Injury – FS-6100-16 If medical expense is incurred with NO LOST TIME, the case will be paid by the agency through APMC.

3. Injury – Form OWCP – 1500 Health Insurance Claim Form (Must be used by the medical provider for billing. Provider may send directly to OWCP if desired)




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B. Information to be sent to the Forest Supervisor will include:

1.

All forms from Section A.

2.

Incident report by Unit Manager.

3.


Forest Supervisor/Deputy Forest Supervisor with mitigation recommendations to preclude or minimize affects of causal activity.

Serious Injury: - lost time (COP) with medical expense.


A.


B.


C.

OWCP Coordinator (within 1 working day)

D.


E.


F.


G.

Regional Safety Officer (by Forest Safety Officer within 2 working days)



1.

Injury – CA-1 Completed and submitted within 30 days of injury.


Supervisor and given back to the employee. OWCP Coordinator should

submit completed form to OWCP within 10 days from the date the form

is completed by the supervisor.

2.

Injury – CA-16 Completed within 4 hours of injury, if possible. In an emergency, where there is no time to complete form, authorize medical treatment by phone and forward completed form to medical facility within 48 hours.

3.

Injury – Form OWCP – 1500 Health Insurance Claim Form Must be used by the medical provider for billing. Provider may send directly to OWCP if desired.

4.

Incident report by the Unit Manager.

The employee MUST furnish the supervisor with medical evidence of any disability within 10 days of injury in order to claim lost time (COP).

B. Information to be sent to the Forest Supervisor will include:

1.

All forms from Section A.

2.

Incident report by Unit Manager.

3.

Transmittal letter from Unit Manager to Forest Supervisor with mitigation recommendations to preclude or minimize affects of causal activity.

NOTE: Serious injury or illness require an incident brief to the Forest Safety Officer within 24 hours and a full report within 12 working days.




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Occupational Disease/Illness: - COP with medical expense.


A.


B.


C.


D.


E.


F.




1. Illness– CA-2 Completed and submitted within 10 days of injury.


Supervisor and given back to the employee. OWCP Coordinator should

submit completed form to OWCP within 10 days from the date the form

is completed by the supervisor.

2. Illness – CA-35a-h for the disease/illness claimed.

3. Illness – Form OWCP – 1500 Health Insurance Claim Form (Must be used by the medical provider for billing. Provider may send directly to OWCP if desired)

Occupational Fatality/ or One or More Private Citizens die (or death likely)/ or One or

More Employees, Enrollees, and/or Private Citizens hospitalized as result of Forest Service

Activities: An investigation will be commissioned by the Forest Supervisor/Deputy Forest

Supervisor in these situations.

Notification of Incident: Contacts will be made immediately regardless of the time of day.

Provide as much of the information as possible in your initial telephone contact.

A.

Unit Manager (District Ranger or Forest Staff Officer)

B.

Forest Supervisor/Deputy Forest Supervisor (by Unit Manager)

C.

Forest Safety Officer (by Unit Manager)

D.

Forest Personnel Specialist (by Unit Manager)

E.

Regional Safety Manager (by Forest Safety Officer)

F.

WO (by Regional Safety Manager)

G.

OSHA (by Forest Safety Officer – within 8 hours of incident or within 8 hours of notification)

Information to be sent to the Forest Supervisor/Deputy Forest Supervisor will include:

A. An incident report summarizing the details of the incident (what, when, where, who).

B. A recommendation on individuals to involve on the investigation team.




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C. The results of formal investigation will be made available to the Regional Safety Manager within 14 calender days of incident.




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Exhibit 4

MOTOR VEHICLE ACCIDENTS INVOLVING CDL DRIVERS

Alcohol or controlled substance tests for CDL operators are not required when CDL operators are driving, or a passenger of a passenger car or, multi-purposed passenger vehicle (cars, SUV’s, and pick-ups, including six passenger pick-ups).

Alcohol and controlled substance tests must be administered (as soon as practical) when:

Type of accident Citation issued to the

CDL Driver

Fatality Yes

No

Bodily injury with immediate medical treatment away from the scene

Yes

No

Test must be performed by the Employer

Yes

Yes

Yes

No

Disabling damage to any motor vehicle requiring towing

Yes

No

Yes

No

Alcohol tests: Must be administered within 2 hours following an accident. If the employer cannot administer the test within this time period, there must be written documentation as to why. If the test cannot be administered within 8 hours the employer is to cease attempts to administer the test and document why the test could not be administered.

Controlled substance tests: Must be administered within 32 hours following an accident. If the test cannot be administered within 32 hours the employer is to cease attempts to administer the test and document why the test could not be administered.




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Exhibit 5

Motor Vehicle Accidents and Post Accident Drug Testing

Drug testing is required when, based upon the circumstances of the accident, an employee’s actions are reasonably suspected of having caused or contributed to an accident.

If the accident results in: a) death or personal injury requiring immediate hospitalization; OR b) the accident results in damage to government or private property estimated to be in excess of $10,000.

Procedures:

The appropriate supervisor will present facts and circumstances leading to and supporting the above suspicion to Human Resources Specialist, Joy Bolyard. Use form attached, Exhibit 7.

Joy Bolyard will request approval from APO, James Frey (R9-RO-HR), before testing may occur.

Once approval has been obtained and arrangements made for testing, the supervisor will prepare a written report detailing the facts and circumstances that warranted the testing.

Supervisors will then meet with the employee and provide the employee with necessary documentation (see Exhibit 7), and, if appropriate, transport the employee to the drug testing collection site.

Timeframe

Drug tests must be administered within 32 hours following the accident. If the test cannot be administered within 32 hours, the employer is to cease attempts to administer the test and document why the test could not be administered.








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Exhibit 6

Supervisory Procedures for Post-Accident (and other appropriate officials)

Post accident drug testing criteria are met when a and b OR a and c below apply: a. Accident occurred while employee was performing safety-sensitive duties, e.g., driving a vehicle, operating a boat, carrying/use of a firearm, or performing work activities that involve the use or operation of equipment for which a Job Hazard Analysis is required, e.g., using a chainsaw, AND the employee’s actions are reasonably suspected of having caused or contributed to the accident which resulted in b or c below.

b. Death or personal injury requiring immediate hospitalization (admitted for treatment on an inpatient basis) OR c. Damage to government or private property estimated to be in excess of $10,000.

(estimate is an aggregate amount of damage reasonably estimated by an agency official using an objective basis).

If the above conditions apply, and a determination has been made that the employee’s actions are reasonably suspected of having caused or contributed to the accident, a postaccident drug test must be completed as soon as possible, but not later than 32 hours after the accident.

Procedures:

Present the facts and circumstances, preferably in writing, leading to the request for postaccident testing to your servicing HR office or locally designated official. (See Documentation

Guide for PA Drug Testing, page 13).

Servicing HR office or locally designated official requests Regional Office approval to drug test employee. If PA drug test is approved, 1) locally available drug test kit is transported to collection site OR 2) drug test kit is ordered thru the SMART system by HR. Servicing HR office confirms drug test kit is available by calling clinic/collection site. Follow guidelines below that apply to the case at hand. Supervisor meets privately with employee to:

 Inform employee of the reason for the test.

 Provide employee with copy of the written documentation (Documentation Guide for PA

Drug Testing, page 13).

 Order and direct the employee to undergo the drug test.

 Provide employee a copy of the RSPA Employee Information Sheet & Privacy Act

Statement (pgs 14-16).

 Transport employee, and drug test kit (if locally available) to the collection site.




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 Prepare any relevant follow-up documentation.

 If the test is not done, document why the test was not accomplished and submit documentation to the Regional Office thru your servicing HR office.




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Exhibit 7

DOCUMENTATION GUIDE for PA Drug Testing (Use additional pages, as necessary)

Description of Incident: (Include date, time, place, names/addresses of witnesses, if applicable)

1. Post-Accident criteria are met when a and b OR a and c below apply:

___a. Accident occurred while employee was performing safety-sensitive duties, e.g., driving a vehicle, operating a boat, carrying/use of a firearm, work activities that involve the use or operation of equipment for which a Job Hazard Analysis is required, e.g., using a chainsaw, AND the employee’s actions are reasonably suspected of having caused or contributed to the accident which resulted in b or c below.

___b. Death or personal injury requiring immediate hospitalization (admitted for treatment on an inpatient basis) OR

___c. Damage to government or private property estimated to be in excess of $10,000.

(estimate is an aggregate amount of damage reasonably estimated by an agency official using an objective basis).

2. Do not consider whether you believe drug or alcohol use caused or contributed to the accident.

Do explain whether or not the employee’s actions are reasonably suspected of having caused or contributed to the accident:

Management Official’s

Signature/Date____________________________________________________

Immediately submit this completed form to your servicing HR office or locally designated official.

FOREST SERVICE HANDBOOK MARK TWAIN NF (REGION 9) ROLLA, MO

FOREST SERVICE HANDBOOK

MARK TWAIN NF (REGION 9)

ROLLA, MO

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FOREST SERVICE HANDBOOK MARK TWAIN NF (REGION 9) ROLLA, MO

FOREST SERVICE HANDBOOK

MARK TWAIN NF (REGION 9)

ROLLA, MO

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