Accident Reporting and Investigation

In the event of a fire, large chemical spill, or any incident where immediate emergency medical attention is needed, please call 911 immediately!

If you are not sure outside help or medical attention is needed, contact Campus Safety at 603-358-2228. In the event of a motor vehicle accident, small gas spill, or small chemical spill, contact Campus Safety at 603-358-2228.

An employee who experiences an accident or is injured while at work should report information about the incident immediately to their supervisor. If non urgent medical attention is required, Keene State College worker’s compensation medical providers are either the Emergency Room at Cheshire Medical Center or Convenient MD.

How/Where To File a Report For a Work Related and/or on Campus Injury/Incident:

Work related injury/incidents Employee Responsibilities

For minor injuries that do not require medical attention beyond simple first aid (band aids, ice pack, etc.):

• You should attend to your injury first.
• Then report the injury to your manager (or delegate) as soon as you are able to. You and your manager should fill out an incident report form and submit it via a ticket to the USNH Benefit & Leave of Absence team.

For more serious injuries that require medical attention (office visit, ER visit, ambulance ride, etc.):

• You should seek medical attention as soon as possible. If you need an ambulance, please call 911 or seek assistance from Campus Safety 603-358-2228.
• Have someone notify your manager if you are unable to do so.
• When you arrive at the medical facility, notify them that this is a work-related injury. Before you leave, make sure that you get a New Hampshire Worker’s Compensation Medical Form. The USNH Benefits & Leave of Absence will need this form to file your claim with the state and with our insurance agency (MEMIC Indemnity). This form lets us (your employer) know if you are allowed to return to work, whether you are on full duty or light duty, if you have any restrictions, etc. This is a very important document for the process and if we don’t receive it, we don’t have the information we need to help you through the Worker’s Compensation process, or to know if we need to accommodate any restrictions you have at work. This form needs to be submitted via a ticket to the USNH Benefits & Leave of Absence team or you can call Help Central at 603-358-2525.
• If applicable, upload supporting documentation along with the incident report.
• Communicate with your manager on what your treatment is and your expected return to work date.

Slips, Trips, and Falls (icy conditions during winter, tripped over a hole in the sidewalk, or a pothole in a parking lot, slipped on a wet floor, etc.):

• Call Campus Safety at 603-358-2228
• Campus Safety will respond and document the incident. This is done by interviewing the person, interviewing any witnesses, taking pictures of the injury (if the person is agreeable and consented), and taking pictures of the area where the incident occurred.
• Seek medical attention if something doesn’t feel right.
• Follow the Worker’s Compensation information above if seeking medical attention.
• Copies of the report are sent to the USNH Benefit & Leave of Absence team via a ticket, and the Environmental Health and Safety Coordinator, Julie Kroupa, at julie.kroupa@keene.edu.

Work related Injury/Incidents Manager Responsibilities

• The manager (or delegate) should notify the USNH Benefit & Leave of Absence team via a ticket and Environmental Health and Safety Coordinator, Julie Kroupa, at julie.kroupa@keene.edu as soon as possible after the incident- Proper incident investigation is almost useless unless it is conducted close to the time of incident. The USNH Benefits & Leave of Absence team will handle all worker’s compensation filing and paperwork, and Julie will determine if an incident investigation is necessary.
• An incident report form should be filled out by the manager and employee together. If the employee is taken out of work because of the injury, the manager can contact the employee by phone (if possible) to complete the report.
• Once completed, all incident report forms should be submitted via a ticket to the USNH Benefit & Leave of Absence team with a copy to Environmental Health and Safety Coordinator, Julie Kroupa, at julie.kroupa@keene.edu within 2 days of the incident.

Bystander Responsibilities

• If you see someone get injured, offer support and assistance. Make note of their status, and if it is a medical emergency, call 911 or Campus Safety (i.e., they are not breathing or have lost consciousness).
• Make notes about the conditions and circumstances of the incident, particularly in the case of slip, trip or falls. Forward those notes to the employee’s supervisor, HR or EHS.
• Stay with the injured party until Campus Safety or EMS are on scene, or until you are assured the injured person appears able to manage on their own.
• Community members are strongly encouraged NOT to transport severely injured parties in personal vehicles in case of medical complications and increased personal liability.

Non-Employee/Visitor Incident Reporting Responsibilities

• Non-employee/visitor incidents should be reported to Campus Safety.
• Non-employee/visitor incidents will be forwarded to USNH Risk Management for review and procedural process.

Forms and Contacts

Incident reports can be found here: incident report form

USNH Benefits and Leave of Absence 603-358-2525 or ticket

Julie Kroupa, Environmental Health and Safety Coordinator Julie.kroupa@keene.edu 603-358-2859

Campus Safety ksccampussafety@keene.edu 603-358-2228

The incident report form should be used to report any accident, injury, occupational illness, or near miss incident involving a KSC employee, student, contract employee, or visitor to the campus.

If you see something you believe to be a hazard, please notify the EHS department by emailing julie.kroupa@keene.edu or submit a Facilities Maintenance Request Order which can be found under the Facilities section of the KSC Webpage.