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Cal Poly Pomona
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Reporting Incidents/Accidents

While none of us want accidents to happen, they do occur and University Risk Management needs to be notified promptly so we can act on behalf of the University, as needed. Environmental Health & Safety must be notified in order to assess safety and prevention concerns, both current and future.

An incident is any unusual occurance; an employee, student, or visitor accident (with or without injury); a disturbance that could disrupt campus operations; a violation of policy; or a mishap due to equipment failure.

How to Report an Incident/Accident

It is the responsibility of every employee to report accidents and/or near-misses to their manager when they occur.

If an employee, student, or visitor is injured, immediately report all details to your manager. In the event of a medical emergency, always dial 9-1-1 from any on-campus telephone. If using a cell phone to report an on-campus emergency, dial 909-869-3070.

This will connect you directly with the University campus police dispatcher who can send a police officer and if needed, emergency medical personnel. Call University Risk Management at 909-869-4846 to report the details of the incident.

Managers shall notify University Risk Management immediately (within 24 hours). If the incident/accident results in injury/illness to a Cal Poly Pomona employee, please refer to the section below on "How to Report an Employee Work-Related Illness/Injury."

For accident investigation purposes, and in accordance with the campus Injury and Illness Prevention Program, managers need to report all accidents to Environmental Health & Safety, extension 3695, in addition to notifying University Risk Management. Environmental Health & Safety also has a form that is to be utilized to document the investigation of an accident, injury, or near-miss incident on their website at: www.csupomona.edu/~ehs/ftp/IIPPForms/Accident.doc

Remember: If in doubt as to whether or not the situation is an emergency, treat it as an emergency and follow the steps listed above.

How to Report an Employee Work-Related Illness/Injury

All employee related incidents must be reported within 24 hours to University Risk Management. Information and procedures regarding how to report an employee work-related illness/injury are provided on the Workers' Compensation website at the following link: (www.csupomona.edu~rp/wc.htm).

Reporting Vehicle Accidents

All vehicle accidents occuring while on University/State business, must be reported immediately (within 48 hours), regardless of whether the vehicle is a University/State, rental, or private vehicle. The report needs to be made on the State of California's Report of Vehicle Accident Form (STD. 270) , available at (http://www.documents.dgs.ca.gov/dgs/fmc/pdf/ std270.pdf), and be immediately submitted to:

Risk Management Services
Cal Poly Pomona
CLA Building 98, Room B1-35
3801 W. Temple Avenue
Pomona, CA 91768
Telephone: 909-869-4846

Employees must not make any admission as to who was at fault, nor make any attempt to settle claims or otherwise establish liability with the other parties to the accident or their insurance companies.

An employee who is involved in a vehicular accident must not discuss the accident with anyone except:

  • Investigating Traffic Officers
  • Employee's Supervisor/Manager
  • Authorized Cal Poly Pomona/State Officers
  • Cal Poly Pomona's Risk Manager (Valerie Eberle) and Workers' Compensation Claims Analyst (Maribel Nerio)
  • State's Insurance Adjusters

If driving a University/State vehicle at the time of an accident, the employee should refer to the Accident Identification Form (STD. 269), located in their state vehicle's glove compartment for instructions and information. This card provides a convenient place to write down pertinent information while still at the accident scene. The Accident Identification Form is also available on-line at http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std269.pdf.

If driving a private vehicle at the time of an accident, the employee should refer to their private insurance carrier's instructions for reporting and/or claiming an accident.

Subsequent to any accident involving a State vehicle, all communications and forms, including Summons and Complaint, must be forwarded to University Risk Management.

The immediate supervisor/manager who authorized or permitted the employee to use the vehicle will ensure that the employee completes the Std. Form 270 or will do it for him/her if the employee is unable to do so. The supervisor will also inform University Risk Management, when the employee is unable to do so. The immediate supervisor/manager who authorized the employee to drive on State business must also prepare the State Driver Accident Review - Supervisor's Review Form STD. 274, and forward it to University Risk Management within five days from the date of the accident.

Injuries Resulting from Motor Vehicle Accident

Should an accident result in bodily injury to anyone other than the state employee, the accident must be immediately reported to the State of California's Office of Risk and Insurance Management (ORIM) by telephone or an advance faxed copy of the Accident Report Form STD. 270. On weekends, call (916) 376-5295 to leave a Voice Mail. This notification is required in addition to notifying University Risk Management at (909) 869-4846.

Forms for Reporting Incidents or Accidents

Links to Other Related Sites