Stanford University

Serious Injury/Illness Reporting Procedures

What is a serious injury/illness?

Per Cal/OSHA regulation, employers shall report any work-related serious injury, illness, or death to Cal/OSHA as soon as practically possible, but not longer than eight hours after the incident. Cal/OSHA defines an injury or illness as serious if it:

  • Requires inpatient hospitalization for reasons other than medical observation or diagnostic testing
  • An employee suffers a loss of any limb of the body
  • An employee suffers any serious degree of permanent disfigurement

Stanford reporting procedure

In the event of serious injury, illness, or death:

  1. Call the EH&S Emergency Hotline at (650) 725-9999 immediately. (During non-business hours, this number will reach a University operator, who will collect incident information and contact EH&S.)
  2. The Occupational Health and Safety (OHS) Program staff will take the facts about the incident and the status of the injured employee(s) from the supervisor and/ or the employee(s).
  3. The OHS Program staff will report the incident to the Cal/OSHA district office.
  4. The supervisor must complete the requisite forms (refer to the table below or contact Risk Management at (650) 723-7400).
  5. The supervisor must follow up on the incident and document corrective actions (using the Incident Investigation Report). EH&S will review all forms and contact supervisors as needed for follow up. The goal of incident investigations is to prevent incidents from recurring, not to assign culpability.

Who calls Cal/OSHA?

  • EH&S is the designated University authority to report serious incidents to Cal/OSHA. The EH&S emergency reporting number (5-9999) is monitored 24 hours a day.
  • Supervisors and co-workers must not contact Cal/OSHA directly to report serious incidents.

What are the time limits for reporting?

  • EH&S shall report all serious incidents, injuries, and illnesses to the nearest District Office of Cal/OSHA as soon as practically possible, but not longer than eight hours after the incident.
  • Failure to immediately report serious incidents and injuries to EH&S can result in Cal/OSHA citations and fines. Note that regulatory violations are paid by the operating unit responsible for the citations.

Additional information on incident reporting at Stanford University

  • See the table below for Stanford University work-related incident/injury/illness reporting forms.
  • If necessary, contact EH&S at (650) 723-0448 or visit the IIPP website.
  • If necessary, contact the Office of Risk Management at (650) 723-7400.
  • Review the Stanford University Administrative Guide:
    • Emergency/Accident Procedures (25.2)
    • Accident and Incident Reporting (25.6)

Stanford University work-related incident/injury/illness report forms

Supervisors are responsible for reporting all work-related incidents, injuries, and illnesses. See below for the reporting required.

Incident/injury/exposure report forms

Form When To Use Instructions
SU-17 – Incident Investigation Report Any incident involving a Stanford University employee, student, visitor, and/or contractor (note: use the SU-17B for non-University employees) Submit to Risk Management within 24 hours
State Form DWC-1 (workers compensation) Provide to employees when they visit a doctor due to a work-related injury/illness Complete and provide to employee within 24 hours of incident or report of incident
SU-16 – Workers’ Compensation Lost Workdays Report Provide to employees and Risk Management when they visit a doctor due to a work-related injury/illness. Supervisors/HR Managers must complete and provide to the employee within 24 hours of incident or report of incident.
Cal/OSHA 5020- Employer’s Report of Occupational Injury or Illness Supervisors/ HR Managers must complete for employees when treatment is required by a physician/provider in a medical facility. Submit to Risk Management as soon as possible, but within 5 days

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