Procedures that apply to all DOC incident investigation, reporting, and record keeping requirements relating to the DOC Safety and Health Program are included in this Chapter. The following areas are within the scope of this reference:

1. Accidental injuries, occupational illnesses, fatalities of all DOC employees;
2. Motor vehicle accidents;
3. Accidental damage to government property or equipment other than motor vehicle;
4. Accidents that result in injury to non-DOC personnel; or
5. Accidents which result in property damage to non-government property.

The Department is responsible for providing safe and healthful work places and conditions of employment for all employees. Prompt investigation and reporting of any accident or occupational illness involving Commerce employees or property will provide information necessary for the systematic identification and correction of safety and health hazards.

Form CD-137, Report of Accident/Illness (Revised 5/89). The four part form shall be completed and copies distributed as follows:

1. Pink copy to the employee;
2. Yellow copy to the employee’s supervisor;
3. Golden Rod to the Safety Representative;
4. White copy to the Departmental Safety Manager, Office for Federal Assistance and Management Support, Office of Management Support. When the Form CD-137 is completed by an operating unit Safety Representative outside of Washington DC and in an area serviced by an ASC, the copy normally sent to the Departmental Safety Manager shall be sent to the ASC Safety Manager.

Form CD-137 shall be used to report accidents/incidents involving:

1. Employee injury, illness or death;
2. Motor vehicles;
3. Federal property;
4. Non-Federal person (visitors, sightseers, contractor employees, etc) and Federal property; and/or
5. A combination of Federal employees and non-Federal persons and/or government or non-Federal property.

Form SF-91, Operator’s Report of Motor Vehicle Accident and, where appropriate, Form SF-94, Statement of Witness, may be used to record witness identity and accident/illness information, but shall not be used in place of Form CD-137.

Employee
Each employee, or someone acting on the employee’s behalf, is responsible for the prompt reporting of all accident/illness to his/her supervisor. In addition, the employee is responsible for:

1. Completion of Items 1 through 16 of Form CA-1 for each traumatic injury sustained while in the performance of his/her job.
2. Completion of Form CA-2 for each occupational illness or disease sustained in the performance of his/her job.
3. Timely submission of accident/illness information and workers compensation forms his/her supervisor.

Supervisor
Each supervisor is responsible for the timely submission of the following forms:

1. CD-137, for each person involved in the accident/illness. Once the CD-137 is completed, it shall be distributed in accordance with paragraph 4.a. of this Chapter.
2. Completion of Items 21 through 45, Form CA-1, and obtaining witness information (where appropriate) for the completion of Items 17 through 20.
3. Department of Labor Forms CA-1 and CA-2 shall be forwarded, when completed to the person designated by the head of the operating unit or ASC Director and assigned the responsibility for coordinating and submitting worker’s compensation claims.

The servicing personnel officer should have up-to-date information about the filing of these claims to the centralized Department of Commerce Worker’s Compensation Center.

Safety Representative (as appropriate)
The operating unit/ASC Safety Representative shall enter Form CD-137 information on FORM OSHA No. 200, Log of Federal Occupation injuries and Illnesses (or a computer generated facsimile thereof). A copy of the CD-137 and Form OSHA No. 200 shall be retained by the Safety Representatives for a period of five years following the close of the accident/illness report’s calendar year.

1. Statements from witnesses, photographs, investigate and other supporting data shall be attached to the Form CD-137 and retained by the preparing Safety Representative. In those instances where a claim could be filed against the Department, a copy of the CD-137 and other investigative evidence shall be sent to the Departmental Tort Claims Officer, Departmental Office of the General Counsel, as soon as possible after the accident/illness.
2. All Safety Representatives shall verify the accuracy of each report and, where authorized, ensure the timely electronic transmission of accident/illness data.

The Department of Commerce is required to report, immediately, accidents of a significant nature to the Department of Labor. The Department official responsible for the injured employee(s) or damaged property shall report the following incidents, by the quickest method available, to the appropriate Safety Representative who shall inform the departmental Office of Federal Assistance and Management Support. The Director of Federal Assistance and Management Support has designated the Chief, Health and Safety Division as the Departmental Safety and Health Program Manager. The Departmental Safety and Health Program Manager may designate a person(s) to assist in the investigation of:

1. Any occupational accident which is fatal to one or more employees;
2. Any occupational accident which results in the hospitalization of five or more employees or which involves property damage of $100,000 or more;
3. Any occupational accident involving Federal or non-Federal employees which results in a fatality or the hospitalization of five or more individuals.

The report of the investigation shall include:

1. Date, time and location of the accident/incident;
2. Names and other identifier information of all persons involved;
3. Number of deaths;
4. Number and extent of injuries/illnesses;
5. Extent of damage to property; and
6. Any other information necessary for the completion of Form CD-137

Accidents not immediately reportable, but which result in death within six months of the date of the accident, shall be reported to the appropriate Safety Representative within 24 hours from the time the supervisor or other responsible official becomes aware of the death.