In the instance of a crime or emergency,immediately contact 911. Download the presentation and post the campus-approved message throughout our buildings, online, and shared spaces. Help communicate the new home of reporting problems at diversity.uiowa.edu/report. You will need to finish filling out the form in one session. The university community can report prejudice or discrimination incidents securely online to the Office of Institutional Equity (OIE) or the Campus Inclusion Team. The driver's accident report form consists of the following four pages. Elevators & Conveyances 1:54. Our mission is to minimize the risk of financial loss to the University through the identification and analysis of risk, implementation of loss control programs and contractual transfer or other risk reduction or financing techniques. Bidder Preference Otherwise, hit next. If you are injured at work, always inform your supervisor and seek medical attention at the appropriate facility (listed below)whenevernecessary or if you are advised to do so. (height, weight, hair color, sex, description or clothing, etc. Once completed, this form will route to the next level of supervision for their approval. 2. The employee is encouraged to keep a copy of this document for their records. Your name (if not apparent from your e-mail address): Web: https://hr.uiowa.edu/tat E-Mail: uitat@uiowa.edu Phone: 319-384-2955 Incident Reporting Step 1 of 4 25% If the incident is currently taking place, please notify your supervisor or call 911 if it is an emergency. This form should be used to investigate a work related employee injury or illness. Supervisors and UI Human Resources representatives will be notified via email when an incident is reported for their department online or by paper form. University Counseling Service (for students), Supporting mental well-being and helping students succeed at Iowa, Womens Resources and Action Center (WRAC). Report all misuse, or abuse of campus IT resources, or incidents involving system/ network compromises or the disclosure of sensitive and or personal information to the Information Security and Policy Office for further investigation. Names of other members of your organization who were present. ): Student Care & Assistance provides assistance to University of Iowa students experiencing crisis and emergency situations. What type of issue does the incident involve (System/ device/ account/ Identity compromise? Commission Reference CFR Citation Supporting the campus community with compassionate-solution based strategies for individuals experiencing distress or grievances through outreach, intervention, and de-escalation to mitigate the risk of planned physical harm to others or self. Daniel Slim/Getty Images. This report will be sent to the employee when it is reported that the employee will miss (or hasmissed)threedays of work. If you see something, please say something. Page 3: Accident report form (steps 1 through 7) Page 4: Accident report form (steps 8 through 10) After signing the completed accident report form, mail pages 3 and 4 (you do not need to . 2551 HOLIDAY RD A3. The University of Iowa-Incident Form can be used to report all incidents with the exception of incidents within University Hospitals and Clinics, auto accidents or workers compensation claims. Otherwise, fill out all boxes below and give as much information as possible. The First Report of Injury form needs to be filed electronically at theHR Self-Service sitewithin 24 hours of the incident. About Office of Institutional Equity (OIE) The Office of Institutional Equity (OIE) Contact Title IX and Gender Equity Monique DiCarlo, Director of Title IX and Gender Equity, Title IX Coordinator 455 Van Allen Hall The University of Iowa Iowa City, IA 52242 319.335.0705 Email: oie-tixge@uiowa.edu Offices are open Monday - Friday, 8 a.m. - 5 p.m. URL of this page: https://www.lib.uiowa.edu/forms/incident-reporting/ Print date: 30 July 2023, Special Collections & University Archives, Borrowing From Another Library & Document Delivery, Undergraduate Research Services (The SEAM). Usually, labor laws specify the kind of information that should . The University of Iowa is a place where all people should feel safe and included. UI Risk Management implemented the online Vehicle Accident Reportingto improve both the convenience and efficiency of auto claims. Hourly Employees: Page 2: Accident codes used in the form. An Alabama woman who vanished after calling 911 to report a child walking along an interstate last week reappeared at her home two days later and told investigators a detailed story . Iowa City, IA 52242, Non-emergency: 319-335-5022 VisitSexual Harassment & Misconduct Resourcesfor more informationInvestigative proceduresTitle IX Coordinator, The equal employment opportunity, affirmative action, and compliance unitimplement diversity policies at the University of Iowa and supports the universitys compliance with federal/state laws and regulations and university policies employment opportunity, affirmative action, and its compliance, We serve as a resource to support the university's compliance with federal/state laws and regulations and university policies prohibiting discrimination, harassment, retaliation, and sexual harassment by or towards any UI community member.Equal employment opportunity, affirmative action, and compliance director. Azure Service Health helps you stay informed and take action when Azure service issues like incidents and planned maintenance affect you by providing a personalized health dashboard , customizable alerts, and expert guidance. After hours and emergencies the ISPO on-call staff can be reached by calling the ITS Help Desk: 384-HELP (4357). Monsoon Asians & Pacific Islanders in Solidarity (formerly Monsoon United Asian Women of Iowa) serves victims/survivors of domestic violence, sexual assault and human trafficking in Asian and Pacific Islander (API) communities in Iowa. Thursday, October 27, 2022 Beginning Nov. 1, all vehicle incidents involving University of Iowa vehicles may be reported online in Employee Self Service or MyUI. For information about these changes, as well as what options users have, please visit the Wiki Service Change Options and FAQs page. Following are examples of several forms (and directions when applicable) that you may need to complete when an injury occurs. The exposure involves a splash of material inthe eyes, mouth or nose; The exposed skin has been damaged and is non-intact; or. Contact details: An incident report is a form to document all workplace illnesses, injuries, near misses and accidents. Field Trip Guidelines for Faculty & Staff, Risk Management, Insurance, and Loss Prevention, Training (Employee Self Service): Course #WRM002. ): Open Records Requests Your name and ID number. Ron DeSantis and his team were uninjured after they were involved in a car accident Tuesday in Tennessee, according to his presidential campaign. e.g., what the library might do to affect this stress point; what the staff person might do differently next time; request for follow-up by staff member. "Whether a company loses a factory in a fire or millions of files in a cybersecurity incident . This includes insurance and self-insurance programs covering property and liability risks, including buildings, equipment, fine art, vehicles, fidelity, liability claims and disaster response planning. Environmental Health & Safety Vehicle Accident Reporting Procedures . All work-related incidents should be reported to EHS, including those involving minor spills, fires, or injuries. Wage & Hour, 150 Des Moines Street What you need to know: Starting today, all clinical PCs will have this icon on desktops to access the Safety Incident Reporting system. Incident Reports are used:To report any incident that resulted in an injury/illness to a non-UI employee (such as a student or volunteer)or UI employee (such as a TA). UI Risk Management implemented the online Vehicle Accident Reporting to improve both the convenience and efficiency of auto claims. Unless it falls under an exception to the open records law, a police report is available to the public at a small cost. Copy and paste the information below into an e-mail to help with your case. Austin police ruled an AA worker was killed in April by accident, per the Austin American-Statesman. The NetSuite services displayed on the status page are: Application UI: NetSuite user interface Iowa Division of Labor / Iowa OSHA. Page 1: Instructions for completing the form. Bloodborne Pathogen (blood/body fluid) related injuries-. The following resources are considered non-confidential resources for reporting. We can assist with the identification and analysis of risks and with recommending and developing strategies to best address risks. Once the report is submitted to the UI Benefits Office, automatic e-mail notifications will be sent to the injured employee, their supervisor, and the HR Unit Representative. "This morning, the . This also includes incidents that were near misses that could have caused a very serious injury. Incident Overview. Our mission is to provide free, confidential, trauma-informed advocacy to people affected by sexual violence and promote social change through prevention education. To submit a report, click on the Incident Reporting link found on: Instructions are available here. It includes workplace injuries, near misses, and accidents that have a negative impact on the employee (s) and the organization, in general. Vehicle accidents may now be reported electronically online or by completing a Vehicle Accident Report form and submitting it to Risk Management at, Risk Management, Insurance, and Loss Prevention. To report incidents involving injuries to employees contact University Benefits (5-2676). The Frisco Police Department on Tuesday said the actions of one of its officers during a traffic stop over the weekend are under "comprehensive review.". EMERGENCIES IN CASE OF EMERGENCY DIAL 911 FOR AN EMERGENCY INVOLVING SEXUAL ASSAULT, STALKING, OR DOMESTIC VIOLENCE, CALL THE 24-HOUR RAPE CRISIS LINE (319) 335-6000 How to Report Concerns Watch on Reporting to the Office of Institutional Equity (OIE) USE THE DROPDOWN MENU BELOW TO SUBMIT AN ONLINE REPORT TO THE OIE. Here's one example: CREATE THIS REPORT TEMPLATE Any illness or injury that impacts an employee's ability to work must be noted. Des Moines, IA 50309-1836. Joint Office for Compliance; or Office: 319-384-8282 Anonymous: 319-384-8190 You can access your accident report via our online victims request form, free to passengers or accident injury victims by calling directly (404) 777-9441. They can be reached at 515-281-4776. Pesticide incident reports tell EPA about adverse effects on people, domestic animals (such as pets or livestock), wildlife, or the environment (air, soil, water, plants). risk-management@uiowa.edu. Web: https://hr.uiowa.edu/tat. The equity investigations and ADA compliance unitimplement diversity policies at the University of Iowa and support the universitys compliance with federal/state laws and regulations and university policies prohibiting discrimination, harassment, retaliation, and ADA compliance by or towards any UI community member. Iowa City, Iowa 52242 319-335-3555 Contact Us, Visit the Office of Student Accountability, Rape Victim Advocacy Program (RVAP): 24 hr hotline: (319) 335-6000, Nissa African Family Services(319) 338-7617, Office of Institutional Equity - 319.335.0705, Office of Student Accountability (319) 335-1162, Sexual misconduct, Title IX, and gender equity, Equal employment opportunity, affirmative action, and compliance. Director ofEquity Investigations and ADA Coordinator. 0:04. We are also available to serve on committees or working groups to provide risk management expertise. 2750 University Capitol Centre, Suite 3719 Once completed, this form will route to the next level of supervision for their approval. Criminal histories must be obtained through the Iowa Department of Public Safety. Watch NEWSMAX LIVE for the latest news and analysis on today's top stories, right here on Facebook. Please see theFAQ on the Open Records websitefor more information. Department or Organization: Emergency: 911, https://transparency.uiowa.edu/public-records-requests. Use a clean lab coat to provide the victim with privacy and warmth. 1:42. "This morning, the governor was in a car accident . The Office of Student Accountabilityis dedicated to encouraging responsible community behavior, educating UI students, and facilitatingaccountabilityin situations where violations of the Code of Student Life have occurred. Complete a First Report of Injury and notify EHS of all work-related injuries/illnesses (see below). This list includes mandatory reporters. Go immediately to the eyewash station: Contamination - Thoroughlywash the exposed area with mild soap and water and remove any contaminated clothing. You can utilize this link to a PDF incident investigation formand use itto take notes of your investigation and then transfer the information into the workflow form if you so desire. The entire form must be completed to ensure there is no delay in the processing of your claim. The online reporting tool is in theGeneral Systems and Tools tab on Employee Self Serviceor MyUI. Experiencing sexual misconduct or harassment? Reporting a pesticide incident helps provide EPA with information on the effects and consequences of . The Office of theOmbudspersonis a resource for any member of the university community --including students, faculty, staff, postdocs, residents and fellow--with a problem or concern. Three engines and one hand crew are on scene working to suppress the fire with additional resources en route. Chapter 3 - Inspections, Citations and Proposed Penalties, Chapter 4 - Recording and Reporting Occupational Injuries and Illnesses, Chapter 5 - Rules of Practice for Variances, Limitations, Variations, Tolerances and Exemptions, Chapter 9 - Discrimination Against Employees, Chapter 10 - General Industry Safety and Health Rules, Chapter 26 - Construction Safety and Health Rules, Chapter 28 - Occupational Safety and Health Standards for Agriculture, Chapter 29 - Sanitation and Shelter Rules for Railroad Employees, Chapter 110 - Hazardous Chemical Risks Right to Know - General Provisions. STOP - Do not leave the scene of the accident. You must have JavaScript enabled to use this form. We serve as a resource to support the university's compliance with federal/state laws and regulations and university policies prohibiting discrimination, harassment, retaliation, and sexual harassment by or towards any UI community member. Reports and complaints received on or after August 14th, 2020 will follow the new procedure. Working together, the three units will provide a centralized complaint investigative team, a coordinated intake and record-keeping process, and improved response times to investigations. If the incident occursafter-hours or on a weekend, contact Department of Public Safety (335-5022) who will notify EHS after-hours emergency staff. If you have questions about how to do an incident investigation, ICON courseW526OSIncident Investigation Training is available to assist you with the process or you may contact EHS staff (335-8501)for additional assistance. You can submit an incident report in Riskonnect through: The Point Epic 1 W. Prentiss Street Render aid or assistance to the injured (Section 321.263, Code of Iowa). 1. 200 S. Capitol St. Next, select Vehicle Accident Reporting, and the online tool will walk you through step-by-step how to report your accident. For Teaching Labs: If a student refuses treatment, have the University of Iowa Incident Information Form filled out at the time of the incident. (This form is located within Employee Self-Service under Benefits & Wellness/Workers Compensation/First Report of Injury). Click here for resources. For all work injuries or accidents, employees must receive care from treatment locations authorized by the workers compensation insurance claims administrator to receive benefits for medical payments and work absences. The vehicle damage report is used to collect necessary information, such as details of the driver, vehicle damage, parties involved, and witness statements to support insurance claims. Additional information can be found off the following link: https://its.uiowa.edu/helpdesk, If you are physically threatened in any way please contact Public Safety;Emergency: 911Non-Emergency: (319) 335-5022, Fax: (319) 335-5800Address: 808 University Capitol Centre, 200 S. Capitol Street, Iowa City, IA 52242-5500E-Mail: police@uiowa.eduWeb:https://police.uiowa.edu/, Threat Assessment ProgramSupporting the campus community with compassionate-solution based strategies for individuals experiencing distress or grievances through outreach, intervention, and de-escalation to mitigate the risk of planned physical harm to others or self. As of 2018, Facilities Management, University Housing & Dining, and UI Health Care Department of Nursing usethe updatedEssential and Marginal Functional Job Analysis formin the case ofa new first report of injury submitted through Workers' Compensation. If you have experienced incidents of bias or discrimination, please reach out for support. BLEDSOE, DEMETRIUS JAMES. 2023005845. 2023005845. WORD | Smartsheet. Paper forms will continue to be available in the glove compartment of university vehicles. All accident reports can be retrieved from crashdocs.org. Email . Phone: 319-335-5022, 808 University Capitol Centre If you have questions regarding the completion of any of these forms, contact your supervisor, your claims representative, or the workers' compensation specialist in University Benefits at (319) 335-2676. You will not be able to save your work and return to the same form. One of the KPIs (Key Performance Indicators) of the Incident Vehicle Damage Report Template. On site treatment will depend on the material/hazard you are potentially exposed to: Thoroughlywash the exposed area with mild soap and water and remove any contaminated clothing; eyes should be rinsed using an eyewash. | John Bachman The goal is to develop processes that encourage good work habits, attitudes and management leadership. This includes students who are injured while performing duties for which they receive a stipend. Depending on the material involved, EHS may be required to report the incident to regulatory bodies, as part of the regulations by which we must abide. Ron DeSantis, a leading 2024 Republican presidential candidate, was not injured after he was involved in a car accident in Tennessee Tuesday morning, according to his . In April 2021, the University of Iowa announced it was forming a new Office of Institutional Equity (OIE) under the Division of Diversity, Equity, and Inclusion (DDEI) tostreamline the process of reporting bias, harassment, discrimination, equity, free speech, and sexual misconduct concerns. Some areas where our department provides risk management assistance include: contracts, policies and procedures, vehicle use, continuity planning, insurance needs, loss prevention, claims, activity and event planning. Following submission of the first report of injury form, the supervisor of the injured employee will receive an email with a link to a Workflow Incident Investigation form.

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