Number: 

DAO 209-3

SECTION 1. - PURPOSE.

.01 This Order presents and updates the Department of Commerce (the Department) policies, procedures, forms, and reporting systems used when investigating, recording, and documenting occupational injuries, illnesses, work-related motor vehicle accidents, near miss incidents/events, and major damage to Federal property (as defined in Section 5, Definitions).

.02 This revision reinforces the requirements of the Occupational Safety and Health Administration 's (OSHA) recordkeeping regulations (29 Code of Federal Regulations (C.F.R.) 1904; and 29 C.F.R. 1960.72). According to these recordkeeping regulations, the Department is required to electronically submit to the Bureau of Labor Statistics (BLS) flat files by May 1 of each year, all information included on the Department 's previous calendar year 's occupational injury and illness recordkeeping forms. Consequently, the Department requires each bureau/operating unit to submit to the Department 's Office of Occupational Safety and Health (OOSH) by March 15 of each year all information included on its occupational injury and illness recordkeeping forms for the previous calendar year.

.03 Further, this Order reinforces OSHA 's recordkeeping-related requirements for bureaus/operating units to:

a. Notify OSHA: within 8 hours after the death of any employee resulting from a work-related incident; and within 24 hours after the inpatient hospitalization of one or more employees, or an employee 's body part amputation, or an employee 's loss of an eye, as a result of a work-related incident. (See 29 CFR 1904.39, reporting work-related severe injuries and illnesses.)

b. Complete the accident/incident investigation using a systematic approach to: describe incident-related events and outcomes; identify injured or ill employee(s); determine incident-related root causes; identify and implement corrective actions to prevent recurrence; and implement reporting and recording procedures in a timely manner. (See OSHA publication Incident Investigations: A Guide for Employers and OSHA Fact Sheet: The Importance of Root Cause Analysis During Incident Investigation.)

c. Notify OOSH as soon as practically possible of any work-related fatality, serious incident, and severe injury or illness in order to ensure the most appropriate and expedient response and investigation assistance;

d. Use the DOL, Office of Workers ' Compensation Programs (OWCP), Employees ' Compensation Operations and Management Portal (ECOMP) for electronically processing (filing, reviewing, adjudicating, approving, delivering benefits, controverting, and tracking) OSHA injury and illness incident reports (including severe injury or illness reports) and workers ' compensation claim forms. Examples of DOL forms processed through ECOMP include (but are not limited to): OSHA Form 301, Injury and Illness Incident Report; Workers ' Compensation (WC) Forms CA-1, Federal Employee 's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation; and CA-2, Notice of Occupational Disease and Claim for Compensation;

e. Complete Form CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality (or other bureau/operating unit-specific equivalent) as a supplemental and optional form for documenting incident investigations such as: property damage and near miss incidents/events (see Sections 7.04 and 8.02). Note: Completing incident investigations is mandatory, while use of the Form CD-137 for documenting property damage and near misses is optional.

SECTION 2. - AUTHORITY.

The legal authorities for this Order are:

a. Title 29 C.F.R. Part 1960, "Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters," which pertains to the reporting and investigation of work-related injuries, illnesses, accidents/incidents, and fatalities (e.g., 29 C.F.R. 1960.29 - Accident investigation; 29 C.F.R. 1960 Subpart I - Recordkeeping and Reporting Requirements);

b. Occupational Safety and Health Act of 1970, 29 United States Code (U.S.C.) 651 et seq.;

c. Title 29 C.F.R. Part 1904, "Recording and Reporting Occupational Injuries and Illnesses";

d. Executive Order 12196, "Occupational Safety and Health Programs for Federal Employees"; and

e. Federal Employees ' Compensation Act (FECA); 5 U.S.C. 8101 et seq., which provides compensation benefits to civilian employees of the United States for disability due to personal injury or disease sustained while in the performance of work duty.

SECTION 3. - POLICY.

.01 The Department is responsible for providing safe and healthful workplaces and conditions of employment for all employees.

.02 Prompt reporting, investigation, and recording of any work-related injury, illness, accidents/incidents, fatality, serious incident, severe injury, near miss, motor vehicle accident; or any major damage involving Federal property or equipment and Department employees, contractors (directly controlled/supervised on a day-to-day basis by Department personnel), visitors, or property will provide important information for the systematic identification of incident-related root causes, the correction of occupational safety and health hazards, and prevention of work-related injuries/illnesses.

.03 The Department 's responsibility for providing safe and healthful workplaces and conditions of employment for its employees is expressed through implementation of the following Department Administrative Orders (DAOs): 202-810 Workers' Compensation for Federal Employees; and 209-4 Occupational Safety and Health Program.

.04 The Department is responsible for using ECOMP to electronically process OSHA injury and illness incident reports and using ECOMP for electronically processing WC claim forms.

.05 In carrying out responsibilities under this Order, all Department officers and employees and contractor personnel must comply with Department policies and practices concerning confidentiality and whistleblower protections and all applicable provisions under the Privacy Act, 5 U.S.C. 552a, the Whistleblower Protection Act, 5 U.S.C. 2302, and any other related law, regulation, or policy

SECTION 4. - APPLICABILITY AND SCOPE.

This Order applies to all Department bureaus, agencies, offices, operating units, and contractor personnel (directly controlled/supervised on a day-to-day basis by Department personnel).

SECTION 5. - DEFINITIONS.

The following definitions, adopted from applicable OSHA regulations, are relevant to this Order:

a. Accident/Incident. - A work-related (sudden or non-sudden) event that resulted in an injury, amputation, loss of eye, illness, fatality, any fire (except as required for maintenance or scientific activities), property damage (as defined in Section 5 and resulting from a safety-related accident/incident), or a near miss that could have resulted in an injury, fatality, or property damage. Even minor injuries such as cuts or sprains are considered accidents/incidents. The term work-related accident/incident excludes spills/releases and radiation release-related incidents that do not involve personal injury or personal exposure. If there is any doubt, treat the situation as if it were an accident/incident.

b. Amputation. - The traumatic loss of a limb or other external body part. Amputations include a part, such as a limb or appendage, that has been severed, cut off, amputated (either completely or partially); fingertip amputations with or without bone loss; medical amputations resulting from irreparable damage; amputations of body parts that have since been reattached. Amputations do not include avulsions, enucleations, deglovings, scalpings, severed ears, or broken or chipped teeth.

c. Collateral Duty Safety Officer (CDSO) also known as Safety Coordinator/Specialist. The CDSO is the person designated by the head of a bureau, operating unit, or regional center, and assigned the responsibility for implementing the occupational safety and health program within his/her organization.

d. Contractor.- An individual or firm that agrees to furnish materials or perform services at a specified price and controls the details of how the work will be performed and completed. Department establishments hosting contractor employees are responsible for providing a safe and healthful work environment where/when Department personnel, on a day-to-day basis, directly control and/or supervise the contractor employee 's work activities.

e. Establishment.- A single location where business is conducted or where services are performed. Typically, an establishment refers to a field activity, regional office, an area office, installation or facility.

f. First Aid.- First aid refers to medical attention that is usually administered immediately after the (minor) injury and usually at the establishment where it occurred. It often consists of a one-time, short-term treatment and requires little technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor burn; applying bandages and dressings; the use of non-prescription medicine; draining blisters; removing debris from the eyes; massage; and drinking fluids to relieve heat stress.

g. Hazard/Hazardous Condition.- An observable situation or condition that could result in injury, illness, and, or equipment/property damage, and risk exposure to an individual if not addressed and mitigated.

h. Incipient Stage Fire. - A fire that is in the initial or beginning stage and which can be controlled or extinguished by portable fire extinguishers.

i. Injury or illness. - An injury or illness is an abnormal condition or disorder. Injuries include cases such as, but not limited to, a cut, fracture, sprain, or amputation. Illnesses include both acute and chronic illnesses, such as, but not limited to, a skin disease, respiratory disorder, or poisoning. (Note: Injuries and illnesses are recordable to OSHA only if they are new, work-related cases that meet one or more of the part 1904 recording criteria. Some recordable injuries and illness are also reportable to OSHA and are referred to as severe injuries and illnesses.)

j. Inpatient Hospitalization. - A formal admission to the inpatient service of a hospital or clinic for care or treatment. Treatment in an Emergency Room only is not considered a severe injury and therefore is not reportable to OSHA.

k. Medical Treatment. - Medical treatment means the management and care of a patient to combat a disease, disorder, injury, or illness. For the purposes of 29 C.F.R. Part 1904, medical treatment does not include visits to a physician or other licensed health care professional solely for observation or counseling; or the conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (for example, eye drops to dilate pupils); or first aid treatment.

l. Motor Vehicle. - Any self-propelled mechanically- or electrically-powered vehicle designed to be operated principally on a roadway for the transportation of property or passengers.

m. Motor Vehicle Accident. - Any occurrence involving a Federal Government-owned, leased or rented motor vehicle (GOV), or privately-owned motor vehicle (POV) operated on official business, which results in death, injury, or property damage, regardless of whom (if anyone) was injured or what property was damaged. Note: In the event of a vehicle accident, report drivers cited with felony traffic violations while operating a GOV.

n. Near Miss. A near miss (also called a "close call" or "near hit") describes an incident where no property was damaged, and no injury or illness was sustained, but where a slight shift in time, position, or action, and damage and/or injury easily could have occurred. Near misses should be reported so conditions that led to the near miss can be corrected before injury, illness, or property damage occur.

o. Non-Vehicle Property Damage Accident/Incident. - Any accident/incident, other than motor vehicle, which involves Federal real property or Federal personal property. The appropriate Real Property Manager and/or Personal Property Custodian must be informed as soon as practicable of the accident/incident and potential dollar damage.

p. Occupational and/or Work-Related Injury or Illness. - Relating to employment, the work environment, and/or places of employment.

q. OSHA Recordable Injury or Illness.

1. Any work-related fatality,

2. Any work-related injury or illness that results in loss of consciousness, days away from work, restricted work, or transfer to another job,

3. Any work-related injury or illness requiring medical treatment beyond first aid,

4. Any work-related diagnosed case of cancer, chronic irreversible diseases, fractured or cracked bones or teeth, and punctured eardrums,

5. There are also special recording criteria for work-related cases involving: needlesticks and sharps injuries; medical removal; hearing loss; and tuberculosis.

These injuries and illnesses must be recorded on OSHA Form 301 (Injury and Illness Incident Report) and OSHA Form 300 (Log of Work-Related Injuries and Illnesses). This definition is not all inclusive; therefore, consult with OSHA Recordkeeper. This definition does not include "first aid treatment," where first aid is immediate and temporary treatment of a victim of sudden illness or injury.

r. OSHA Recordkeeper (ORK). - The ORK is the person designated by the head of a bureau, operating unit, or regional center, and assigned the responsibility for reviewing and processing OSHA Form 301 reports filed by employees using ECOMP (or another bureau/operating unit-specific, equally effective electronic reporting system) to report a work-related injury or illness. The ORK is also responsible for performing all other work-related injury and illness recordkeeping functions required by this Order, OSHA 's recording and reporting occupational injuries and illness rule (29 C.F.R. Part 1904), as well as OSHA 's recordkeeping and reporting requirements for Federal agencies (29 C.F.R. Part 1960, Subpart I).

s. Root Causes. - A causal factor of an event and/or incident that, if corrected, would prevent the recurrence of that and similar events. Generally, root causes concern the underlying reasons why unsafe conditions exist or if a procedure or safety rule was not followed in a workplace. Root causes generally reflect management, design, planning, organizational or operational failings (e.g., a damaged guard had not been repaired; failure to use the guard was routinely overlooked by supervisors to ensure the speed of production).

t. Serious Incident. - A condition that results in one or more of the following event outcomes:

1. Severe Injury or Illness as defined below.

2. Treatment of one or more persons, including Federal employees, non-Federal employees, and employees of Federal contractors, admitted as inpatients to a hospital as a result of a single event that occurred while they were performing their assigned work duties;

3. Property Damage. - Property damage is damage amounting to $25,000 or more (other than vehicles). Vehicular damage is damage in excess of $5,000, or if the vehicle is totaled, or whenever there is a fatality or catastrophe related to the property damage;

4. Radiation Exposure resulting in any personal exposure;

5. Biological or Chemical Exposure when in the judgment of competent authorities, the exposure is considered serious;

6. Non-DOC Agencies. - Whenever a DOC organization alerts another governmental (Federal, State, or local) agency to the existence or suspected existence of a chemical, biological, radiological, nuclear, or explosive exposure event; and

7. Facility Evacuation. - Activation of an Occupant Emergency Plan resulting from:

i. A fire beyond the incipient stage;

ii. Shelter-in-place or evacuation due to threats (e.g., suspicious package, vehicle/bomb threat, toxic material release, etc.); and

iii. Any criminal act of hostility/violence (e.g., active shooter, assault, rioting, or terrorism).

u. Severe Injury or Illness Also Known as OSHA Reportable Injury or Illness. - A work-related OSHA Recordable Injury or Illness that employers must also report to OSHA as follows: (1) within 8 hours after the death of any employee as a result of a work-related incident; and (2) within 24 hours after (i) the inpatient hospitalization of one or more employees (ii) an employee 's amputation or (iii) an employee 's loss of an eye, as a result of a work-related incident (29 C.F.R. 1904.39).

v. Traumatic Injury. - A condition of the body caused by a specific event or incident, or series of events or incidents, within a single workday or shift. Such condition must be caused by external force, including stress or strain, which is identifiable as to time and place of occurrence and member or function of the body affected. The term "traumatic injury" is associated with the processing of WC claims.

SECTION 6. - RESPONSIBILITIES.

Employee.

.01 All employees have a personal responsibility to prevent accidents/incidents. - Employees are expected to observe safe practices, procedures, rules, and instructions relating to the efficient handling of their work tasks, work areas, maintenance areas, and other establishment areas where work operations are performed.

.02 Employees are responsible for reporting all work area hazardous conditions, near miss incidents or any circumstances that they consider unsafe to their supervisor, Bureau Safety Manager/Coordinator/ CDSO, or to OOSH.

.03 Upon sustaining a work-related injury or illness, employees (or someone acting on the employees ' behalf) are responsible for:

a. Reporting all accidents/incidents or illnesses to his/her supervisor as soon as practicable and making reasonable efforts to do so prior to the end of the shift during which the accident/incident occurs, or within 24 hours;

b. OSHA Form 301: - Using the ECOMP system for electronically processing OSHA Form 301, Injury and Illness Incident Report (upon sustaining a work-related injury or illness). The injured or ill employee will be required to file an OSHA Form 301 within 4 calendar days of sustaining a work-related injury/illness, before filing a WC claim (Form CA-1 or Form CA-2). Filing an OSHA Form 301 does not generate a WC claim. Instead, after completing the OSHA Form 301, the injured/ill employee must elect to file a WC claim (usually within 30 calendar days of sustaining the work-related traumatic injury or illness). If the injured/ill employee files an OSHA Form 301 first (as required by ECOMP), and then chooses to file a WC claim by completing a Form CA-1 or Form CA-2, then the data entered in the OSHA Form 301 will automatically populate the claim Form CA-1 or Form CA-2.

c. WC Form CA-1: - Using the ECOMP system for completing the WC Form CA-1, Federal Employee 's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, for each traumatic injury sustained while in the performance of his/her job, if the employee elects to file a WC claim. Using ECOMP to complete OSHA Form 301 will prompt the system to ask the injured employee if he/she also wants to fill out Form CA-1. The data entered in the OSHA Form 301 will automatically populate the claim Form CA-1. Note: Form CA-1 cannot be used for occupational illness claims.

d. WC Form CA-2: - Using the ECOMP system for completing WC Form CA-2 (Notice of Occupational Disease and Claim for Compensation) for each occupational illness sustained in the performance of his/her job, if the employee elects to file a WC claim. Using ECOMP to complete OSHA Form 301 will prompt the system to ask the occupationally ill employee if he/she also wants to fill out Form CA-2. The data entered into the OSHA Form 301 will automatically populate the claim Form CA-2. Note: Form CA-2 cannot be used for traumatic injury claims.

e. Obtaining and submitting appropriate medical documentation (using ECOMP 's Document Upload feature, available from the ECOMP homepage), within 10 calendar days of sustaining the work-related injury/illness) from the affected health care provider (e.g., the attending physician) that specifies the employee 's current medical condition and any work-related restrictions or limitations; and

f. Submitting accident/incident information to his/her supervisor in a timely manner combined with use of ECOMP for completion of OSHA Form 301, Form CA-1, or Form CA-2.

.04 Supervisor. - Each supervisor is responsible for the following:

a. Assisting an employee who has reported a work related injury or illness to: obtain appropriate medical attention as quickly as possible; report injuries to bureau/operating unit workers ' compensation specialist/Bureau Safety Manager/Coordinator/CDSO/ORK, where these are in place; use ECOMP to complete OSHA Form 301, WC claim Form CA-1 or CA-2 (if the employee elects to file a WC claim);

b. Conducting a systematic and thorough investigation of the work-related injuries and illness, near misses and property damage cases by gathering incident-related facts and details sufficient to complete the questions (e.g., the who, what, when, where, and why) associated with various incident reporting forms (e.g., ECOMP OSHA Form 301, WC claim Form CA-1, optional Form CD-137). Further, when appropriate (e.g., serious incidents and severe injury accidents), seek technical guidance from the Bureau Safety Manager/Coordinator/CDSO or OOSH safety and health specialist regarding the incident investigation. A thorough investigation should include the following: description of incident-related sequence of events, facts and outcomes; gathering statements from witnesses; obtaining photographs of location, equipment, and hazards associated with the incident (documenting the scene); obtaining investigative and other supporting data and documentation (e.g., work practices, work procedures, personal protective equipment (PPE) use requirements, etc.); identifying incident causes; identifying corrective actions; implementing corrective actions in a timely manner to prevent a recurrence; and conducting follow-up.

c. Reviewing, correcting as appropriate, and approving OSHA Form 301, WC claim Form CA-1 or CA-2 (within 3 calendar days) filed in ECOMP by an injured employee.

.05 Safety Managers/Coordinators/Specialists/CDSOs/ORKs. Each safety manager/coordinator/ specialist/CDSO/ORK is responsible for the following:

a. Reviewing and verifying the accuracy of the OSHA Form 301 and that it has been submitted through ECOMP, which must be completed within seven calendar days of receiving information that a recordable injury or illness has occurred regarding all employees on payroll, whether they are labor, executive, hourly, salary, part-time, seasonal, or migrant workers;

b. Assisting the supervisor of an employee involved in a work-related accident/incident to conduct a thorough investigation of the accident/incident using a systematic approach;

c. Sending a notification of a serious incident to the Department's General Litigation Division, Office of the General Counsel, Herbert C. Hoover Building, Room 5890, Washington, DC, 20230, telephone (202) 482-1069, fax (202) 482-5858 as soon as possible after the accident/incident in those instances where a claim could be filed against the Department;

d. Informing the servicing Security Office (as appropriate) and the Department 's OOSH immediately of any severe injury/illness or serious incident affecting one or more workers in a Department-owned or leased establishment, facility, vessel, aircraft, or work-related operation or activity. This requirement applies to Federal employees, contractors, associates, or visitors;

e. Contacting the nearest OSHA Area Office within 8 hours of learning of a fatality or within 24 hours of learning of an inpatient hospitalization of one or more employees, an amputation, or a loss of an eye (severe injury) resulting from a workplace incident. Such reports of severe injuries/illnesses can be made by the bureau to the OSHA Area Office nearest to the site where the severe injury occurred; to OSHA 's toll-free central telephone number at (800) 321-6742; or to OSHA 's public Web site by using the reporting application known as the Serious Event Reporting Online Form. The OOSH director may designate a qualified person to assist in the severe injury/illness investigation;

f. Submit to OOSH by March 15 of each year all information included on the bureau/operating unit 's occupational injury and illness recordkeeping forms for the previous calendar year (data for submission to the BLS flat files). Note: the information submitted must include all data entered on the operating unit 's OSHA Form 300, Log of Work-Related Injuries and Illnesses; OSHA Form 301, Injury and Illness Incident Report; and OSHA Form 300A, Summary of Work-Related Injuries and Illnesses. OSHA Form 300 is used to log the recordable injuries and illnesses within seven calendar days of receiving information that a recordable injury or illness has occurred regarding all employees on payroll, whether they are labor, executive, hourly, salary, part-time, seasonal, or migrant workers. OSHA Form 300-A summarizes information from OSHA Form 300 for use in annual reporting;

.06 OOSH, in the Department 's Office of Human Resources Management (OHRM), will:

a. Collect, analyze, and report data (e.g., using ECOMP) on work-related accidents/incidents, injuries, and illnesses, and associated costs (e.g., workers ' compensation) of accidents/incidents to identify trends;

b. Take appropriate action to assist management and Safety Managers/Coordinators/Specialists/CDSOs/ ORKs in reducing those trends and preventing accidents/incidents and illnesses;

c. Take appropriate action to consolidate the occupational injury and illness recordkeeping data submitted by the operating units by April 30 of each year; and

d. Take appropriate action to electronically submit to the BLS by May 1 of each year all information included on the Department 's previous calendar year 's occupational injury and illness recordkeeping forms (28 CFR.1960.71(a)(1)).

SECTION 7. - PROCEDURES.

.01 The Department is required to report severe injuries and illnesses to OSHA within specified timeframes (e.g., work-related fatality within 8 hours, inpatient hospitalizations of one or more employees, amputation and loss of an eye resulting from a work-related incident within 24 hours). If appropriate, such reports can be made by the bureau/operating unit to the OSHA Area Office nearest to the site where the incident occurred, to OSHA 's toll-free central telephone number (800) 321-6742 or to OSHA 's public Web site by using the reporting application known as the Serious Event Reporting Online Form.

.02 In addition, severe injuries/illnesses and/or serious incidents must be reported immediately to OOSH at (202) 482-4935. This reporting requirement also applies to Federal employees, visitors, contractors, or personnel on the premises who become injured. The Department or bureau/operating unit official responsible for the injured personnel or damaged property shall report such accidents/ incidents by the quickest method available to their bureau 's Safety Manager/Coordinator/Specialists/ CDSO who shall inform OOSH immediately. The OOSH Director may designate a qualified person to assist in the investigation of severe injury and/or serious incident;

.03 The details surrounding the work-related injury and/or illness accident/incident (including severe injuries and illnesses) shall be recorded using ECOMP for completion of OSHA Form 301, Injury and Illness Incident Report ;

.04 The details surrounding near miss incidents and property damage may be included in optional Form CD-137. Additionally, circumstances and details surrounding property damage and/or near miss incidents are to be documented using bureau/operating unit specific reporting systems or, as an alternate option, by completing Form CD-137. Examples of relevant documentation to be generated as part of the incident investigation include: description of circumstances leading up to the incident; detailed description of how, who, what, when, where, and why the incident occurred; detailed description of relevant worker training; statements from witnesses; photographs of incident location, tools, and equipment involved, equipment and infrastructure damage (documenting the scene); descriptions of equipment, tools, work practices, procedures, and protective measures involved; description of damage and hazards associated with the incident; investigative and other supporting data; identification of system failures and/or root causes; identification of recommended/planned corrective action(s); description of implemented corrective action(s); and conducting follow-up. If the incident is documented outside of the ECOMP system a Form CD-137 shall be completed by the supervisor or other qualified investigator within 5 working (business) days of the incident. Delays in completing the investigation must be justified/supported by valid reasons. Examples of such reasons include: the complex nature of the incident; gathering relevant evidence; gathering witness statements or samples; awaiting laboratory testing results; seeking appropriate and qualified technical expertise; awaiting engineering analysis results/reports.

.05 Accidents/incidents not immediately reportable to OSHA, but which result in death within 30 days of the date of the accident/incident (severe injury/illness), shall be reported to the appropriate Safety Manager/Coordinator/Specialist/CDSO/ORK within 24 hours from the time the supervisor or other responsible official becomes aware of the death. The Safety Manager/Coordinator/Specialist/CDSO/ ORK will report the death to OSHA, as well as OOSH, within 24 hours of becoming aware of the death.

.06 Accidents/incidents not immediately reportable to OSHA (where the onset of the full injury is not immediate), but which result in delayed inpatient hospitalization, amputation, or loss of an eye (e.g., within the first 24 hours after the event) are considered severe injuries. Therefore, such delayed severe injury cases must be reported to the appropriate Safety Manager/Coordinator/ Specialist/ CDSO/ORK within 24 hours from the time the supervisor or other responsible official becomes aware of the delayed severe injury. The Safety Manager/Coordinator/Specialist/CDSO/ORK is then required to report the delayed work-related severe injury to OSHA, as well as OOSH, within 24 hours of becoming aware of the delayed severe injury.

.07 Accidents/incidents involving damage to property may be reported on Form CD-52, Report of Review of Property and may be submitted electronically or by hard copy. The employee involved in the property damage incident and his/her supervisor are responsible for completing Form CD-52 and submitting it to the appropriate Safety Manager/Coordinator/ Specialist/ CDSO/ORK within 5 calendar days of the property damage incident.

.08 Alternatively, property damage and/or near miss incidents/events may be reported by using the supplemental and optional Form CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality (or other bureau/operating unit-specific equivalent). The employee involved in the near miss incident and his/her supervisor are responsible for completing Form CD-137 and submitting it to the appropriate Safety Manager/Coordinator/ Specialist/ CDSO/ORK within 5 calendar days of the near miss incident. As indicated in section 7.07 above, Form CD-52 also may be used to report damage to property. One of these two forms (e.g., Form CD-52 or Form CD-137) must be used to report property damage incidents or events.

SECTION 8. - FORMS.

The following forms are required to report work-related accident/incident, injury, and illness, motor vehicle accident or damage (government vehicles and personnel vehicles being used for government business), and real or personal property/equipment damage:

.01 ECOMP incident reporting forms (e.g., OSHA Form 301 Injury and Illness Incident Report; OSHA Form 300 Log of Work-Related Injuries and Illnesses; WC claim Form CA-1 Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation; and CA-2 Notice of Occupational Disease and Claim for Compensation).

.02 Form CD-137 or Form CD-52 may be used to report property damage and/or near miss incidents/events.

.03 Form SF-91, Motor Vehicle Accident Report, and, where appropriate, Form SF-94, Statement of Witness may be used to record witness identity and accident/incident Information.

SECTION 9. - EFFECT ON OTHER ORDERS.

.01 This Order supersedes Department Administrative Order 209-3, dated July 20, 2015.

.02 Nothing in this Order shall have the effect of or be construed as an exception to the investigative authorities and responsibilities of the Inspector General under Department Organizational Order (DOO) 10-13, "Inspector General," October 21, 2020.

Signed by: Director for Human Resources Management

Approved by: Deputy Chief Financial Officer and Director, Office of Financial Management

Office of Primary Interest: Office of Human Resources Management