All staff and students are advised to make themselves aware of UCCs internal reporting procedures, UCC policy on reporting of accidents and dangerous occurence incidents and risk management imperatives. Note:UCC users are advised that the pdf copies of accident forms are for information purposes only. Please do not download to use. The official A3 size carbon copy forms are available at Department level and from the Health and Safety Office.
Responsibility for ensuring that the relevant forms are completed and circulated rests with the relevant Head of School/Department/Section or his/her nominee in all cases.
Note:UCC users are advised that the pdf copies of accident forms provided hereunder are for information purposes only. Please do not download for the purpose of reporting an incident. The official A3 size carbon copy forms are available at Department level and from the Health and Safety Office.
UCC Reporting Forms and Investigation System
The UCC Accident and Dangerous Occurrence Incident Reporting format comprises four discreet forms, comprising staff/non-staff report forms and an investigation form. They are as follows:
Form1: Staff Accident Report Form ( Sample - not for use) Form 1 Staff Accident Report Form (458kB) (to be completed by the School/Department/Section Head or nominee)
Form 3: Non Staff Accident Report From ( Sample - not for use). Form 3 A Non Staff Accident Report Form (457kB) (to be completed by the injured person and the School/Department/Section Head or nominee)
Form 2: Dangerous Occurence/ Near Miss Incident Report Form ( Sample - Not for use)Form 2 A Dangerous Occurrence/ Incident Report Form (425kB)
Form 4: Incident Investigation Report Form ( Sampe - not for use)Form 4 Accident/Dangerous Occurrence Investigation Report Form (457kB)to be completed by the relevant School/Department/Section Head or nominee in all cases - subject to an exemption for incidents of a very minor or superficial nature which could not have resulted in more serious consequences and which have been reported in full using Forms 1,2 or 3 as appropriate.
For expediency, forms 1,2,&3 refer the reader to classification codes (Please see updated classification document following below of Q4 2015 which superceeded that previously issued to all UCC Departments). These relate to the pre-selection of regular descriptive data with respect to the following:
(a) Type of injury
(b) Parts of body most seriously affected
(c) Type of Dangerous Occurrence
(d) Incident locations
Each form is produced in a colour coded multiple carbon copy format. Circulation instructions are summarised in the next section.
Note: Serious accidents or serious dangerous occurrences should be immediately reported to the School/Department Safety Officer. Such incidences should also be immediately phoned through to the relevant Head of Function/College, the Insurance & Claims Officer and the Risk Management Officer at extension 2800 (both c/o of Office of Corporate & Legal Affairs), General Services Supervisor and to the University Safety Officer at extension 2817
Responsibility for ensuring that the relevant completed forms are circulated in a timely manner rests with the relevant Head of School/Department/Section or his/her nominee in all cases.
(Each form is produced in a colour coded multiple carbon copy format. Circulation instructions are contained on the bottom of each form and are summarised below.)
The University Safety Office is to be sent a carbon copy of all forms ( 1 to 4). The School/Department of origin is to retain a copy of each form (the blue copy in all cases).
The Department of Human Resources is to be sent the staff related accident reports only ( Form 1),
The Corporate Secretary is to be sent the staff and non-staff accident reports. (Form 1 and 3).
The relevant Staff Safety Representative is to be sent a copy of Forms 1 and 2 only, i.e. Staff Accidents and Dangerous Occurrences. (The relevant Safety Representative is the person elected for the constituency in which the incident occurs. Current details on Safety Representatives for the various constituencies in UCC are available at the following link : UCC Staff Safety reps
A copy of the Accident/Dangerous Occurrence Investigation Report Form - Form 4 is to be additionaly sent to the Corporate Secretary, Office of the Corporate & Legal Affairs, UCC.
Carbon copies of the relevant forms must be placed in the internal post for circulation within 24 hours of the accident/occurrence. Serious accidents or serious dangerous occurrences should be immediately reported as set out in the previous section.
UCC's internal reporting and investigation system, as described in the preceeding section, exists to aid prevention and to expedite Corporate risk management, Legal ( SHWW Law) and Insurance requirements.
In order to learn from incidents, recognise trends and to prevent recurrences ( AFARP) and establish the necessary documentation of an accident or potential loss claim involving an employee, student or property, each School/Department has been provided with an Accident and Dangerous Occurrence Report Forms Folder which contains all the relevant forms.
All UCC constituent Colleges, Schools, Departments and Institutes are obliged to adhere to same and the timelines for reporting.
Corporate risk management and Legal ( SHWW Law) and Insurance requirements and accident / dangerous occurence definitions are as outlined in the section link Definitions & Context : Accidents/Dangerous Occurrence.