HomeMy WebLinkAboutAO 53 Incidents with Liability Reporting Procedures 10291986 Superseded v
j` • MEMORANDUM 53 ,
TO : Management Te October 29 , 1986
FROM : Gary Crutchfiel C Manager
SUBJECT : ADMINISTRATIVE ORDER RE : INCIDENT REPORTS .
We have received the " Incident Report Form" which Greg explained to
us at a previous management team meeting and , now that everything
is ready , the attached Administrative Order is formally issued to establish
policy and procedures as to the reporting of incidents with potential
liability . Each and every employee is expected to receive a copy of the
Order .
In addition , Greg will be setting up various meeting times for next week
in order to answer questions for , as well as explain the procedures and
policy to, all employees . Please note that I expect each and every
employee to attend one of the meetings made available ; this matter is an
important element of our risk management program and we need the full
understanding and cooperation of all employees to maximize its potential .
Thank you .
GC : ps
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A � MI N ( STRATI VE ORE> ER NO . 53
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TO : All
Departments
to
O
P October 29 , 1986
FROM : Gary Crutchfield , t anager
SUBJECT : " INCIDENTS" HA NC POTENTIAL FOR
LIABILITY/ REPORTING PROCEDURES .
DEFINITION : " An Incident" is something that happens which may result
in someone alleging liability against the City . When a City employee
observes or is involved in an incident, the following procedure shall be
followed :
I . PURPOSE : To establish policy and procedures for the investigation
and reporting of all incidents having a potential for liability of the
City to any person , including City employees .
11 . RESPONSIBILITY : All employees of all departments and divisions .
III . INCIDENTS - WHAT TO DO : When a City employee is involved
in , or observes any type of incident which could become a claim ,
or could involve City liability , the following shall be done :
• 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 .
b ) DO NOT ADMIT LIABILITY OR STATE THE CITY WILL TAKE
CARE OF DAMAGES . R_ EFER ALL QUESTIONS TO THE CITY
ATTORNEY !
c ) DO NOT GIVE YOUR EXPLANATION OR OPINION AS TO
WHY AN ACCIDENT HAPPENED TO THE VICTIM OR ANY
WITNESS , SAVE ALL STATEMENTS FOR THE CITY ATTORNEY
AND YOUR SUPERVISOR .
d ) Serious incidents should be hp oned into your department
or division head , who shall report the incident to the City
Attorney .
e ) Record all details of the incident to include names , time,
exact location , statements made , and your observations either
on the Incident Report Form or in your field notebook for
reference and later transcription to an Incident Report Form .
BE OBSERVANT AND ACCURATE . This information will be
used by the City Attorney and a Claims Adjuster if a claim is
filed . Take pictures when possible and make diagrams where
appropriate .
• f ) Complete the Incident Report Form and send to the City Attorney .
g ) DO NOT DISCUSS THE INCIDENT WITH ANYONE OTHER
THAN YOUR . SUPERVISOR , THE CITY ATTORNEY OR CLAIM
ADJUSTER . Every incident is a potential claim and statements
made by you could result in the City having to assume liabilities
that may not belong to it .
h ) 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 City Attorney
or Claims Adjuster to contact you .
i ) When the City Attorney or Claims Adjuster contacts you ,
be honest in your comments and supply them with all the
information you have .
IV . SUPERVISOR RESPONSIBILITY :
a ) Upon learning of an incident , the departmental or division
head shall insure that an " Incident Report Form" is completed
and submitted to the City Attorney within one ( 1 ) working
day . The supervisor must sign the Incident Report Form .
b ) If any person calls the City regarding an injury or damage
to their personal property , they shall be referred to the
City Attorney .
. V . CITY ATTORNEY :
a ) The City Attorney will file the appropriate Incident Report
Form with the City ' s insurance carrier or take other appropriate
action .
b ) The City Attorney will file a copy of all Incident Report Forms
with the City Clerk .
Vl , CITY CLERK : The City Clerk shall keep and file a copy of all
Incident Report Forms by reference to date, department, name
of potential claimant and type of incident .
VII . EFFECTIVE DATE : This Order is effective Wednesday , October 29 , 1986 .
GC : ps
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CITY OF PASCO
INCIDENT REPORT FORM
This report shall be completed by the person in charge at the time the incident occurred or was discovered.
• Information is to be recorded immediately and this form forwarded to the CITY ATTORNEY. Attach addi-
tional sheets if more space is needed than is provided on this form.
Name(s) of person(s) involved Age Address Phone
1 .
2.
3.
a.m.
Date of Incident Time p.m.
Location (be specific)
Describe all acts and resulting conditions in detail:
If statements were made by the person(s) involved, witnesses or anyone else, identify the person and de-
scribe their statement:
Were pictures taken? _ If so, who has them?
What corrective measures, or assistance (if any) did City Employees take:
WITNESSES:
Name: Addresses: Phone
1 .
2.
3.
Other:
• Reported by Department
Date _
SUPERVISOR'S SIGNATURE