Accident Investigation and Reporting
 
The JHSC will investigate all accidents involving serious injuries within seven days. A member of the JHSC will go out to the accident scene and investigate the incident, talk to employees, find hazards and fill out the Accident Investigating and Reporting Form. JHSC will follow up and make recommendations for corrective actions. They will notify WSIB of any type of injuries, lost time or not and fill out Form 7 and notify the MOL and MOE when needed.
         
Reporting Form

Worker Information
q Employee             q Sub-Contractor
Last Name				First Name
Address
SIN #				Years of Experience
Date of Birth				Date of Hire
Occupation at time of Injury
Details of Injury / Disease   Employee’s Action
Date of Injury				Date reported
Time of Injury	am / pm			Time reported	am / pm
Date last worked				Normal working hours	From          to
Hour last worked	am / pm
What is the injury / disease?
What happened to cause injury / disease? Please explain in detail how the injury happened
Who did you report the injury / disease to?
Where were you when injured / diseased?
Did anyone witness your injury / disease?

 

To your knowledge have you had a previous similar injury / disease? (if yes, please explain)			Yes       No
What actions do you suggest should be taken to prevent similar accidents in the future?
Employee’s Name		Date
Signature

 


































 

Supervisor’s Action
To your knowledge has this worker had a previous similar injury / disease?			Yes         No
Do you have any reason to doubt that the injury / disease is not work related?  (if yes, please explain)			Yes         No
Follow up to accident by supervisor
Follow up to accident by Joint Health & Safety
Joint Health & Safety members
Signatures of the JHS members
What actions should be taken to prevent similar accidents in the future?
Supervisor’s Name		Date
Signature

 
 
 
 
 














































Communication

• All employees receive handout every year
• All management and supervisor are notified of any injuries suffered to their employees

 Training

• Management and JHSC keep up to date on safety issues and WSIB regulations
• Member of the Landscape Ontario/ WSIB Safety Group
• Employees read policy

 Evaluation

• JHSC and management review every spring of every year

 Acknowledgement

• JHSC reviews every spring of every year and make changes and or recommendations as needed