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​​​​​​​​​​Reporting an Injury or Accident

The person in charge must report all injuries and accidents to the Insurance Department. Serious accidents should be reported immediately by phone, email, or other electronic communication. Follow up with written reports. See Work-Related Injury Reporting​ for injuries and accidents involving employees.

Notice requirements

The person in charge at the location must:


Forms to Complete

When an employee is injured, the matter is handled through workers' compensation​. See Section 5.2.8​. Contact the Insurance Department​ at the archdiocese for assistance related to handling and reporting the injury.

When a student in a school or religious education program or a participant in any youth activity sustains a minor injury, complete the Notic​e to Parent/Guardian of Injury to Minor. For serious injuries or accidents, complete the Incident/Accident Re​port ​​(Non-Automobile), and for school students, complete the Myers-Stevens Stu​dent Insu​rance Claim Form as well. See Student Accident Insurance.

When a volunteer is injured, the person in charge must complete the Incident/Accident Rep​ort (Non-Automobile) and submit it to the Insurance Department. Make a copy for record-keeping.

When a third person (e.g., a visitor, parent/guardian, or bingo player) is injured, the person in charge must complete the Incident/Accident Re​port (Non-Automobile) and submit it to the Insurance Department. Make a copy for record-keeping.

When a volunteer, student, or third person slips/trips and falls at the location, also complete the Slip/Trip & Fall Accident Evaluation Checklist.

If the injury or accident involves a vehicle, the person in charge must complete the Accident Report - Auto and Truck ​and submit it to the Insurance Department. If the injury or accident involves an archdiocesan vehicle, the person in charge must also complete the​ DMV SR 1 and submit the forms to the Insurance Department. The Insurance Department will fill out the following sections of the DMV SR 1:  vehicle owner [leave date of birth blank]​, insurance company name, policy number, policy period and policy holder name.

3-19-21

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