Risk Management - Injury & Incident Reporting - Report a Non-Employee Injury/Incident
Download the Non-Employee Injury/Incident Report Form
Overview
- UW-Madison Risk Management requires that all high-risk NON-UW-Madison employee injuries/incidents be reported. This includes, but is not limited to:
- A bodily injury occurs to an Extension Volunteer, Extension Program Participant, or third party as a result of Extension Programs, Events, or Activities;
- Property damage is incurred by a third party as a result of Extension Programs, Events, or Activities;
- An injury/incident occurs that could be classified as "high risk" as a result of Extension Programs, Events, or Activities;
- The report must be filed within 48 hours of the incident.
- Extension has its own SharePoint workflow for submitting these reports directly to Risk Management.
- Follow the instructions on this page for completing a report and submitting to Risk Management.
Determine if the Injury/Incident Requires Submission
Low Risk Injuries/Incidents typically do not need to be submitted. For a definition and examples reference:
Risk Management - Injury & Incident Reporting - What are Low-Risk Incidents?
High Risk Injuries/Incident must always be submitted. For a definition and examples reference:
Risk Management - Injury & Incident Reporting - What are High-Risk Incidents?
Report a Non-Employee Injury/Incident
1) Quickly Intervene to Prevent or Minimize Harm
Safely and quickly intervene to prevent or minimize harm.
2) Contact Relevant Emergency Authorities (If Necessary)
If injuries are involved seek necessary medical assistance, and call 911 first.
3) Document Relevant Details of Incident
- Who: Affected program participant, volunteer, third party, witnesses.
- What: A detailed account of what happened, including actions taken by staff and others.
- Where: Did the incident take place on UW property or in the community. Did relevant environmental factors cause or contribute to the incident?
- When: Time and date.
- Why: Any objective information that contributes to an understanding of the incident's cause or origin.
4) Call your Supervisor
Call your supervisor to initiate the relevant Extension phone tree. If you are unable to reach your supervisor, leave a message and call the next leadership employee(s) in the relevant phone tree. Continue calling and leaving messages until you are able to reach someone.
Provide them with a brief description of the incident and the relevant details of the injury/incident.
Please see these articles for details relevant to this portion of the process:
5) Submit Non-Employee Injury/Incident Report within 48 Hours
- Download a copy of the report form if you have not already.
- Submit following the instructions on the SharePoint Injury/Incident Reporting Site
6) Submit Additional Reports to Other Authorities or Offices
Document and submit any other required/necessary reports to other authorities or offices (e.g. if the county has their own injury/incident reporting process).
7) Prevent Future Re-Occurrence
Assess the situation and make adjustments to prevent future re-occurrence.
Get Help
- If you have general questions regarding extension non-employee injury/incident reporting, contact hr@extension.wisc.edu.
- If you have any questions related to the report form, contact the Office of Risk Management (608) 262-0379.
- If you have any questions related to the Extension SharePoint Workflow, contact helpdesk@extension.wisc.edu.