Incident Reporting Forms

  • All incidents should be reported to a supervisor within 72 hours. 

    Employees will need to meet with their supervisor or a school nurse to fill out a SRRP incident report. Any witnesses should also fill out a Witness form with their supervisor or nurse. A copy of these forms should NOT be kept. 

    For employees who are covered under Worker's Compensations (see list of covered positions below), the Worker's Compensation First Report of Injury form must also be filled out with a supervisor, in addition to the above mentioned SRRP form. This must be submitted to the Healthy Schools and Safety Manager within 10 days of the incident.

     SRRP forms and Worker's Compensation forms are not to be filled out by employee alone and must be completed by trained employees such as a school nurse, administrator or supervisor. 

     All incident Reporting Forms are located in First Class, under CCSD Forms. They are also available in hard copy, if necessary. The supervisors or administrators have copies of the Worker's Compensation form. For supervisor or administrator instructions on incident reporting, please contact Healthy Schools and Safety Manager. 687-4547

    Positions Covered on Worker's Compensation



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