OHS Incident reporting NS Dept. Agriculture and Dept. Fisheries and Aquaculture

In the event of an incident, accident, near miss, injury, security threat, loss or damage to property, or even a health concern, timely reporting is essential. Depending on the event, supervisors and employees may be required to immediately fill out up to three forms. Each form has a different destination and time requirement for reporting. If there'sconfusion about what forms are to be filled out for your incident, contact your supervisor or OHS Administrator Erik Nowak 424-0319 immediately.

Incident Investigation Report Form

This form is required for near misses, safety concerns, and all minor and major incidents including those resulting in physical injury. The incident report form is completed by the employee and his/her supervisor as soon as possible following the incident. The original is to be sent to the OHS Administrator and both employee and supervisor shall retain copies of the form. The time frame for completing this form is at MAXIMUM one week. This form is meant to document acknowledgment of the incident and investigational actions taken, or to be taken by the supervisor, or to allow others to be informed about safety notices. If the situation is serious or complicated, a more formal investigation would be launched.  Original copies of the forms must be sent ASAP to OHS Administer through mail, or Fax.  If incident is serious in nature, contact OHS  Administrator via Phone (424-0319) or email nowakew@gov.ns.ca to notify that incident has occurred, and to ensure all necessary actions are taken.

OHS  Administrator will forward copies of the Incident Report to the JOHSC committees, and for incidents involving the NSAC, also NSAC Safety and Security.

Copies of the incident report should be kept by the employee involved in the incident, and their immediate supervisor.

If the incident involves injury to an employee, WCB Form 67 must be completed. See instructions below.

For incidents involving a severe physical bodily injury to an employee, as defined by the OHS Act, a fire, an explosion, an injury resulting is gross blood loss, dismemberment or a fatality, OHS Division of Labour and Workforce Development has to be notified. Call the OHS Administrator immediately 424-0319 or 483-9256. If the Administrator cannot be reached, contact any member of the executive. Failure to do so may lead to prosecution under the OHS Act. If the incident involves NSAC staff, contact NSAC Security immediately at 893-4190.

WCB Accident Report (Form 67)

This form is required any time there is an injury to staff "out of and arising from the course of employment". This form is to be filled in by the employee and their supervisor and must be sent to Melissa Calnen (Tel: 424-2946) at HR-CSU via fax to 424-8407 within five CALENDAR days of the incident causing the injury. If at the time of incident the employee is not aware of injury, or if injury becomes apparent after time of incident, employee should consult medical advice and submit WCB 67 form immediately, informing both the immediate supervisor and the OHS Administrator. If the employee is unable to complete the form, management will send in the partially completed form. Failure to do so will result in a fine from WCB. There are a variety of circumstances the WCB may compensate for, in addition to lost wages and health care costs. Some of these may include injury and damages while an employee is on travel status, damage to eyeglasses or dental plates etc, if damages occur as a direct result of a workplace incident. The supervisor and the employee must keep copies of the form.

For injuries involving NSAC staff, WCB forms go through the VP Administration's office for sign-off.

General Incident or Loss Report Form

For incidents involving theft, property damage or third-party liability, or 3rd party injury, the General Incident or Loss Report Form from Transportation and Infrastructure Renewal (TIR) needs to be completed in addition to the Incident Investigation Report Form. This form is to be completed in the event of "insurance" types of losses, such as damage to government property, third-party liability (including student incidents at NSAC), motor vehicle accidents or theft. For all incidents, notify the OHS Administrator immediately at 424-0319 or (cell) 483-9256 to make aware of the incident. If the administrator cannot be reached, contact any member of the executive. If the incident involves NSAC staff, students or visitors, contact campus security immediately at 893-4190. For incidents involving the NSAC, Financial Services needs to have the report as close to time of incident as possible. Failure to do so may result in denial of coverage of the loss. For incidents involving Dept. Agriculture, Fisheries and Aquaculture staff/property, General Loss form must be then forwarded to Bruce Langille (TIR) P 424-2390.