1. THE SIMPLE GUIDE: COMPLETING AN INJURY/ACCIDENT REPORT For KPBSD Staff Members

2. What is an Injury Report? The Injury/Accident Report is a record detailing an accident or injury that: A.occurred on school grounds, during the course of a school day, or during a school sponsored activity regardless of time or location and B.caused harm or injury to either a KPBSD student or visitor.

3. Who is the Injury Report For? The report is to be completed for any student or visitor who is injured when any of the following occur:  Emergency medical services are sought.  Additional medical treatment (x-rays, assessment) may be expected.  Injury results in missed attendance on subsequent days.  Injury is the result of an act of violence.  A serious injury to head, neck or spine occurs, regardless of whether medical attention is pursued.

4. Who Completes the Report?  The staff person responsible for the student at time of injury or the nurse initiates the report. The report is available online at: http://www.kpbsd.k12.ak.us/students_parents.aspx?id=19736. http://www.kpbsd.k12.ak.us/students_parents.aspx?id=19736  If on-site, the nurse will be alerted and complete the assessment and later on, the follow up. If not available, the box for no nurse will be checked. The nurse will complete the follow up section when information becomes available.  Witnesses and/or first aid providers will be asked to describe the incident accounts to the person who will complete the report.  The injured person, if alert and oriented, will also provide input for the accident report. In many schools, the nurse coordinates this process and enters statements and data provided by all involved, then submits the report electronically. It is important to know your school’s practice.

5. What Goes in the Report?  Basic demographic data  Injury information  Description of accident  Description of student activity at time of injury  Any unsafe acts or conditions  Safeguards in place and amount of supervision when injury occurred  Outcome of injury/accident  First Aid provided  Witness identification and description of event  Notification of parent/guardian  Responder/Nurse Report  Additional Follow Up  Dates and Signatures

6. What MUST be Given to Parents?  The Student Accident Claim Form with section completed and signed by school official (administrator or nurse)  Cover letter regarding insurance coverage  Appropriate KPBSD Health Services letter regarding injury in addition to notification in person or by phone

7. When Should the Report be Completed?  Preliminary Report: Submit online ASAP (same day is preferred). If severe injury involving ambulance, 911, ER, or hospital follow up, notify Lassie Nelson at 714-8838 to alert her of the situation.  Follow up: Use report (emailed to you following initial report submission), and enter additional information in RED, then forward email to Lassie Nelson.  Finalizing the Report: Collect signatures, sign and date report, make two photocopies (file in school office and nurse’s office). Place originally signed report in district mail and send to Lassie Nelson at District Office.

8. Where Are the Documents and Who Do I Send Reports To?  All student or visitor injury/accident documents are available online on the KPBSD website. Select the employee tab, and click link (Accidents/Injuries) in top left corner, or bookmark the address below. http://www.kpbsd.k12.ak.us/students_parents.aspx?id=19736 http://www.kpbsd.k12.ak.us/students_parents.aspx?id=19736  Once information is entered, you must select SUBMIT to send the report to District Office and Risk Management.  As confirmation of submission, a copy of the report will be sent to your email.  If you do not receive a copy of the report back via email contact Lassie @ 714-8838.  If report is submitted by anyone other than the school nurse, Lassie will forward report to the appropriate school nurse for follow up.

9. Why is the Injury/Accident Report Necessary?  The report is an internal document of the care that was provided and reflects how each KPBSD system functioned in response to an emergency.  The form will be used by KPBSD and KPB Risk Management to analyze accidents/injuries, respond to insurance inquiries and legal challenges, and look at ways of preventing similar occurrences in the future.  The form is for internal use only—the parent/guardian does not receive a copy of the Student Injury Form.

10. Accident Report DO’S  DO present facts—i.e., describe adequate supervision by noting “2 coaches in room” or “teacher in hallway,” etc.  DO completely describe injured body part, including side of body affected.  DO describe incident in OBJECTIVE terms.  DO note correct times. Use your phone to find out when you dialed home to contact parents/guardians.  DO identify safeguards in place (normal actions that keep students safe) such as “student aware of classroom rules” or “staff in hallway or parking lot” or “safety rules discussed with students at beginning of activity or semester,” etc.

11. More Accident Report DO’S  DO document care provided by everyone involved. Ask witnesses to write brief account and include in report. Attach handwritten accounts to document for nurse to keep.  DO ask for help! Your school nurse or administrator should be able to help you. Lassie Nelson in District Office is another great resource.

12. Accident Report DONT’S  DON’T use subjective language. Make it measurable!  DON’T embellish (“I wouldn’t be surprised if…,” “It seemed…,” “I think…,” “It appeared…”)  DON’T state things you are not certain of.  DON’T give extra information.  DON’T use terms that could imply inadequate supervision.

13. Accident Reports from Start to Finish: A Summary  An accident occurs. The school’s emergency response follows posted School Emergency/First Aid Response guidelines.  Student’s supervisor fills out first section of report and submits online, or nurse begins report using information provided by supervisor. Witnesses provide input to be included in report.  When available, nurse enters gathered data and completes nurses’ portion of form. Person preparing report records name of person originating form as well as those of witnesses, then submits report electronically.  School provides parent/guardian with the Student Accident Claim form, insurance memo, and Health Services letter specific to injury.  Follow up: New information is recorded in red on emailed electronic report. This report is then emailed back to Lassie.  The original report with original signatures is sent to District Office via school mail. Copies are made and filed.

14. Accident/Injury Flow Chart