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
