When an employee experiences an on-the-job incident or accident, the employee must immediately notify their supervisor and together complete an Employee Accident-Incident Analysis form.   If an employee is not able to complete the form due to the nature and/or severity of the injury, we ask that a representative of the employee complete the report on their behalf. 

If medical treatment is required, the employee will also need to complete the Report of Job Injury or Illness form, also known as an 801 SAIF form.  Completed forms should be sent to Amy Scoville in Human Resources.

Please remember that Coos Bay School District takes employee safety seriously, reporting of incidents/accidents helps to ensure a safe and productive work environment for all; failure to report an incident/accident can be disciplinary.  If you have any questions please do not hesitate to ask.

Please note, that both of these forms can also be found on Sharepoint-District Forms-Safety.

Employee Accident – Incident Analysis Form

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