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Home My WebLink AboutN-351 - Incidents Having Potential for Liability/Reporting ProceduresCITY OF PASCO ADMINISTRATIVE ORDERS Administrative Order No. 351 Risk Management Subject: Incidents Having Potential for Liability /Reporting Procedures Initial Effective Date: 10/29/86 Revised 12/2/08 / I1 Approved GC 1 The following Administrative Order is effective April 12, 2012 and supersedes Administrative Order No. 53, dated 10/29/86 and Administrative Order No. 318, dated 1212108. I. PURPOSE: To establish policy and procedures for the investigation and reporting of all incidents in which there is personal injury or damage to property (private or City) or having a potential for liability of the City to any person, including City employees. II. DEPARTMENTS AFFECTED: All III. POLICY: When a City employee is involved in, or observes any type of incident in which there is personal injury or property is damaged or which could become a claim, or could involve City liability, the following procedures shall be followed. All incident reports are to be filed with the City's Risk Manager (Deputy City Manager), IV. DEFINITIONS: A. An "Incident" is something that; 1) has occurred which may result in a claim of personal injury or damage to property (private or City); or 2) someone alleging any action or issue that may result in Jability against the City. B. "Injury" means any personal injury that requires first aid treatment (e.g, scrapes, cuts, etc.) or any incident that may require the individual to seek medical attention/treatment in the future (e.g. slip, trip) though no injury may be apparent when the incident occurs. C. "Damage to private property" means any damage to property, real or personal, for which an owner may claim compensation. D. "Damage to City property" means damage of $500 or more to City real property, building, vehicles or equipment. Reportable damage, for the purpose of this Administrative Order, does not include vandalism or reasonable wear and tear on equipment and properties. V. PROCEDURES: A. Give prompt and appropriate assistance as indicated by any City policy, departmental or division policy or emergency conditions. Call 911 for emergency medical assistance if needed, B. Record all details of the incident to include names, time, exact location, and your observations on an incident report form (attached) or any other type of field manual in your possession at the time. Be observant and accurate. This information will be used by the adjuster if a claim is filed and possibly as an aid to our attorney should a lawsuit result. Take pictures if possible. C. If an incident report form is not used at the time of the incident, you should till one out as soon as possible and forward it to your supervisor who will forward to the City's Risk Manager (Deputy City Manager). The Risk Manager will retain a file of all incident reports and forward copies to the City's insurance agents, 1. When documenting an incident, record only facts, not opinions. If there is additional information that should be considered but not put in writing, indicate on the form for the Claims Adjuster or City Attorney to contact you. 2. When the Claims Adjuster or Attorney contacts you; be honest in your comments and supply them with all the information you have. D. Serious incidents should be phoned to the appropriate personnel right away. In the event of an incident involving serious injury, a fatality, or large property loss occurring after regular working hours, Evergreen Adjustment Service may be contacted directly using the 24 -hour phone number of (800)933 -4235. Examples of incidents that should be reported immediately: 1. Auto Fatality 2. Pedestrian Fatality 3. Downed Stop Sign Accident 4. Witnessed Trip & Fall 5. Police Shooting b. Any Serious Injury Involving Member's Property or Personnel 7. Large Property Loss 8. Sewer Back -up 9. Water Main Break 10. Workplace violence of any kind E. Do not admit liability or state that the City will take care of the damages. Refer all questions to the Risk Manager. Do not discuss the incident with anyone other than your supervisor or other authorized personnel. Every incident is a potential claim and statements made by you could result in the City having to assume liabilities that are not warranted. Administrative Order 351 — Incidents Having Potential for Liability /Reporting Procedures Page 2 F. Upon learning of an incident, the Departmental Director or Division Manager shall insure that an Incident Report Form is completed and submitted to the Risk Manager within one (1) working day. The supervisor must sign the incident Report Form. If any person calls the City regarding an injury or damage to their personal property, they shall be referred to the Risk Manager. G. The Risk Manager will file the appropriate incident Report Form with the City's insurance carrier or take other appropriate action and shall keep and file a copy of all forms by reference to date, department, name of potential claimant and type of incident. Administrative Order 351 — Incidents Having Potential for Liability /Reporting Procedures Page 3 CITY OF PASCO INCIDENT REPORT FORM This report shall be completed by the person in charge at the time of the incident occurred or was discovered, Information is to be recorded immediately and this form forwarded to the Risk Manager. An "Incident' is something that; 1) has occurred which may result in a claim of personal injury or damage to property (private or City); or 2) someone alleging any action or issue that may result in liability against the City. "Damage to City property" means damage of $500 or more to City real property, vehicles or equipment" (see Administrative Order No. 351). Attach additional sheets if more space is needed than is provided on this form. Name(s) of Person(s) Involved: Age: Address: Date of Incident: Location (be specific): Describe all acts and resulting conditions in detail: Time: Phone: Employee? Y/N __0 am ❑pm If statements were made by the person(s) involved, witnesses or anyone else, identify the person and describe their statement: Were pictures taken? if so, please attach or identify location of the photographs: What corrective measures, or assistance (if any) did City employee take: WITNESSES: (other than those involved) Name: I. _ 2. Other: Reported by: Date: Department Director/Division Manager Addresses: Department: Date Administrative Order 351 Attachment 1 Phone: