January 20, 2006  
 

 

Reporting Work-Related Injuries

Employees who experience any work-related accident, injury, illness or exposure must report the incident and submit a completed Occupational Accident Report Form (SU-17).

Immediately report the incident to:

·        Your supervisor

·        SLAC Medical Department, A&E Building (Building 41), Room 137
If the SLAC Medical Department is closed, notify the Department by phone at Ext. 2281 or e-mail to mggherman@SLAC.Stanford.edu as soon as possible. Leave a message noting:

o       Your name

o       Nature of the injury

o       Time and date of the occurrence

o       Name of clinic or hospital where you received treatment

Within 24 hours of any occurrence, you must:

·        Obtain, complete, sign, and submit Side A of the Employee’s Statement of an Occupational Accident Report (SU-17).

Forms are available at the SLAC Medical Department. The SU-17 fulfills legal requirements, permits determination of the level of investigation required to generate subsequent reports and suggests possible remediation. You must complete an SU-17 even if you do not seek medical treatment.

Supervisors must promptly complete and sign Side B (Supervisor’s Statement) of the SU-17 and return the form to the SLAC Workers’ Compensation Administrator, MS 11.

Supervisors who do not receive an SU-17 within a few days of a reported injury, must obtain an SU-17 from the SLAC Medical Department, complete Side B, and return the form to the SLAC Workers’ Compensation Administrator, MS 11.

Contact: Sharon Haynes, Workers’ Compensation Administrator, Human Resources Department, Ext. 4533, shaynes@slac.stanford.edu

The Stanford Linear Accelerator Center is managed by Stanford University for the US Department of Energy

Last update Friday January 27, 2006 by TIP