IN CASE OF AN ACCIDENT…
Revised: February 2004
Supervisor
Health & Safety
J.H.S.C
MOL
Accident Investigation Form
Supervisor
Health & Safety
J.H.S.C
MOL
Accident Investigation Form
Emergency Services
Supervisor
Health & Safety
J.H.S.C
MOL
Supervisor
Health & Safety
J.H.S.C
MOL
Accident Investigation Form
LOST-TIME INJURIES
Employee loses time as a result of a work-result of a work-related accident.
Supervisor
Supervisor
JHSC
Accident Investigation Form
PROFESSIONAL MEDICAL TREATMENT
Work-related injury that requires outside professional medical treatment by a medical doctor, surgeon, optometrist, chiropractor, dentist, hospital
emergency, skilled nursing care, drugless practitioner or chiropodist.
Supervisor
Supervisor
JHSC
Accident Investigation Form
FIRST-AID TREATMENT
Minor injury to employee requiring first-aid which under slightly different circumstances could have resulted in any of the above.
Supervisor
Supervisor
JHSC
Accident Investigation Form
PROPERTY DAMAGE
Damage to City of Brampton property without any injury to employee which under slightly different circumstances could have resulted in any of
the above
Supervisor
Supervisor
JHSC
Accident Investigation Form
ACUTE/CHRONIC OCCUPATIONAL ILLNESS
Supervisor
Accident Investigation Form
INCIDENTS
No injury to an employee, damage to property, loss to process which under slightly different circumstances could have resulted in any of the
above
.
Supervisor
Supervisor
JHSC
Supervisor
JHSC
CRITICAL INJURIES
Places life in jeopardy
Produces unconsciousness
Results in substantial loss of blood
Involves the amputation of a leg or arm but not finger or toe.
Consists of burns to a major portion of the body, or
Causes the loss of sight in an eye.
SERIOUS INJURIES
Any in jury resulting in any broken bone or amputation of any body part,
Any head or eye injury
Any injury requiring stitches to close a wound.
Where a worker is struck (directly) by moving equipment or machinery,
A vehicle accident involving personal injury to a worker
A fall from any elevation exceeding four (4) feet
Where a worker is transported to hospital by ambulance
.
Where a worker is overcome by vapors, or
Any incident of fire
Accident Investigation Form
EMERGENCY SERVICES (FIRE, AMBULANCE, & POLICE): 911
Emergency Services
Supervisor
Health & Safety
J.H.S.C
MOL
Emergency Services
Supervisor
Health & Safety
J.H.S.C
MOL
HEALTH & SAFETY FROM 8:30 P.M-4:30 P.M: (905) 874-2158 OR (905) 874-2161
FATALITIES
Results in the death of the injured employee
CONTACT NUMBERS
HEALTH & SAFETY (AFTER 4:30P.M VIA DISPATCH): (905) 458-3420
DOCUMENTATION
MINISTRY OF LABOUR FROM 8:30P.M-4:30P.M: (416) 273-7800
INVESTIGATION
MINISTRY OF LABOUR AFTER 4:30P.M: 1-800-268-6060
NOTIFICATION
JHSC: REFER TO ATTACHED LIST
TYPE OF ACCIDENT
0
