Carver
Procedure: Reporting a Work-Related Injury or Illness
1. Managers/supervisors are responsible for educating all employees on the proper
reporting procedures and the importance of reporting all incidents/accidents in a timely
manner.
2. Any employee (manager or other) who is the first to witness an accident should quickly
access the situation:
a. Secure the incident location; ensure that access is limited to others and that
there is no additional potential for injury
b. Call 911 or identify an individual to call 911 if medical attention is required
c. Locate a first responder to provide guidance and/or first aid if applicable. (see
attached list)
d. Notify your manager/supervisor of the work related injury or illness
e. Be mindful of any employees that may have witnessed the incident
3. Once notified of the incident, if not the first at the scene, the manager/supervisor
should quickly access the situation again as outlined in Step 2.
4. Once the injured employee has been attended to, the manager/supervisor must notify
Human Resources and Georgi Diamond immediately
5. If the accident/incident involves a vehicle, the manager/supervisor must notify Dave
Griessler, Fleet Manager who will notify the insurance carrier.
6. The manager/supervisor must make arrangements to have the post-accident drug
screening; the post-accident drug screening is most accurate when performed within
two (2) hours of the actual incident and should be scheduled as such. This is required for
ALL accidents.
a. If the employee is injured to the point in which they will need to go to a medical
facility, the drug screening should be completed by that facility
b. If the employee does not need medical attention, they will need to be sent to
Northeast Testing Upstate, Inc. You will need to call in advance to let them know
that the employee will be coming and inform them that it is a post-accident
screening. If you do not feel the employee should be driving, make
arrangements to have someone drive the employee to the testing center.
Northeast Testing
21 Everett Road Ext.
Albany, NY 12205
Phone: 518.618.1255
c. In some situations, Northeast will send a representative to the accident site or
one of our locations to perform the screening.
7. Georgi may visit the location in which the accident occurred to take a report and
pictures. Manager/supervisor should partner with Georgi to complete an
investigation.
8. Manager/supervisor must complete the C2, NYS required accident reporting form,
within 24 hours of the incident. Please be sure to be as specific as possible in the
description of the incident. The form can be completed electronically to ensure
legibility and printed to provide your signature.
9. Upon completion, the manager/supervisor must send the form to Human Resources to
process and report as required. Manager/supervisor should finalize the investigation:
Determine route cause and develop a plan of action including corrective actions and
communications to other locations and managers. For guidelines on completing the
investigation, please refer to the “Incident Investigation” document.
10. When finalized, the manager/supervisor should send investigation to Human
Resources. This should be completed within 48 hours of the accident. Important: the
information in the investigation can be helpful to other departments within the
company and ultimately prevent a similar accident from occurring.
*Please contact Human Resources if you have any questions or require assistance.
__________________________________________________________________
Please direct all billing for work related incidents to the following:
Carver Companies
Karin Bourassa, PHR
Human Resources Manager
494 Western Turnpike
Altamont, NY 12009
#518.355.6034
First Responders:
Employee
Chris Caldwell
Barry Catlin
Georgi Diamond
Arthur Falco
Patrick Kerwin
Peter Laraway
Peter Lawton
Matt Lazzari
Chris O’Malley
Chris Raible
Wayne Schell
Susan Wojturski
Brian Masick
Jeff Shaw
Dave Wood
Devon Gardner
Kyle Hazzard
Jeremy Mann
James Federow
Mike Baker
Scott Wright
Chris Whiteley
George McHugh
Linda Haight
Daniel Simeon
Dave Griessler
Cory Hughes
Floyd Hoffman
Peter Farinelli
Kyle Ropeter
Eric Klefbeck
CPR Trained
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First Aid Trained
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Sand & Gravel
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Sand & Gravel
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Construction
Accident/Incident Investigation & Communication:
“Accidents occur by “chance”, incidents occur because something did or did not
happen (root cause).
All good safety systems include an incident investigation program to help capture all the facts
surrounding the situation, so that the “root cause” can be identified and steps can be taken to
prevent the same incident from happening again.
1. There are 4 types of Incidents that need to be investigated:
“Near Miss”: A situation where no injury actually occurred but that could have resulted
in an injury. (Example: Someone tripped and fell but did not get hurt).
“First Aid”: An injury that is treatable by basic first aid either internal to the plant or by
outside medical personnel. (Example: minor cut, bruise, or abrasion).
“Recordable”: An injury requiring more advanced treatment by outside medical
personnel. Example: Broken bone, stitches, prescription medication etc.
“Lost Time”: An injury requiring time away from work. Example: Back injury, surgery
etc.
2. When should the Investigation take place?
 As soon as possible after the event
 No later than 48 hours.
The faster the investigation is conducted, the greater the chance of accuracy and getting
the real picture of what happened.
3. Who Investigates?
 All employees directly involved.
 Immediate Manager/Supervisor.
 Safety Officer.
 Witnesses.

4. A good investigation should determine:
 What exactly happened?
 Who it happened to?
 Where it happened?


When it took place?
Why it happened?....Root Cause?...CRITICAL!
5. Finding the Root Cause.
 Always have everyone involved on the investigation team- add “experts” as
needed such as maintenance technicians.
 Be objective - don’t let personal opinions get in the way of the actual factsNEVER ASSUME ANYTHING!
 Take photos for later analysis (especially items which may not remain such as
spills, tracks, footprints, tools, parts, equipment etc.)
 Collect all related documents such as training records, work place inspections
etc.
 Do not move anything at the scene until the root cause is determined.
 Reconstruct the incident if it is safe and practical.
Always provide medical treatment to those injured FIRST, before conducting an
investigation!
6. Who gives final approval to the report?
 Employee’s Supervisor
 Human Resources
7. What happens to the report?
 The report findings will be communicated internally through a “Safety Alert”
email and posted on safety notice boards so that all location employees are
aware of what happened.
 The report will also be communicated at the next weekly toolbox meeting.
 Based on the report findings an action plan will be developed that identifies any
engineering, training or administrative controls that are needed to prevent this
incident from occurring again in the future.
8. Agency Notifications
Any required filings of the incident with government agencies such as OSHA or MSHA
will be handled by the Human Resources within the regulated government timelines and
using the mandated forms. The “Safety Incident Reporting Form” is intended for
internal use only.