HTML Preview Hospital Incident Report Sample page number 1.
THE JOHNS HOPKINS INSTITUTIONS EMPLOYEE REPORT OF INCIDENT INSTRUCTIONS
SERIOUS INJURY/ILLNESS: If an employee is seriously injured or becomes acutely ill on the job and needs immediate medical
attention, call 911. Examples of serious medical conditions include loss of consciousness, life threatening injury, seizure, and/or
change in mental status. In such cases the employee should be accompanied by a supervisor or coworker. If there is a question of
severity, contact the appropriate clinic for assistance in determining the appropriate care facility. See the list of phone numbers in #5
below.
Employees:
Employees shall wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible
following contact of such body areas with blood or other potentially infectious materials
1. Report any work-related injury or illness, no matter how minor, to your supervisor immediately.
2. Obtain a completed Employee Report of Incident form from your supervisor and proceed to the appropriate clinic listed in # 5 below.
3. For EYE INJURIES report directly to the Emergency Room of the appropriate campus. Refer to policies HSE004. For bloodborne
pathogen exposures, call 5-STIX (5-7849) inside the hospital or 410-955-7849 if you are calling from outside.
4. For needlesticks or other BLOODBORNE PATHOGEN EXPOSURES call the appropriate clinic for further instructions. Refer to
BLOODBORNE PATHOGEN EXPOSURES in Policy HSE004 for details.
East Baltimore Campus: Call 5-STIX 5-7849 immediately. During the hours of 7:30AM – 4 PM, the employee will be given
instructions to report to clinic (Blalock 139) immediately. When the clinic is closed, the STIX message will be on and detailed
instructions will be give to call the STIX physician and the beeper number. Please listen to entire message and follow
instructions. The STIX physician will evaluate & treat as needed. Report to Occupational Injury Clinic the next business day.
Hopkins and BSI employees at Bayview: Call 5-STIX immediately. Call the Bayview Occupational Health Clinic during
clinic hours 8AM – 4:30PM. When Occupational Health is closed, call the nursing supervisor at 0-0190. If you cannot reach
them, call “O” (Bayview Operator) and have the nursing supervisor paged. The supervisor will arrange to have the source patient
tested etc. Report to East Baltimore Campus, Blalock 139 for follow-up the next business day.
Homewood: Call Occupational Health at (410)516-0450 from 8:30AM– 5PM. When Occupation Health is closed, call Security
at (410) 516-7777. Security will page the on-call person to evaluate the exposure.
Hopkins and BSI employees at Howard County Hospital: From 7:30AM-4:30PM report to Employee Health, TCAS
Building, 2
nd
floor. After hours, call the nursing supervisor’s office at (410)740-7773 or on their Spectralink phone at
(410)884-4994. Report to Employee Health the next business day. Follow-up will be done at East Baltimore Campus.
JHCP/SOM Clinics: Call 5-STIX (410-955-7849) immediately. After hours, the STIX message will be on. Listen to complete
message and follow the instructions. The STIX physician’s beeper # is on the message.
Suburban Hospital: call 301-896-3167 immediately 6:30 AM-5:00 PM M-F. All other hours page the Nursing Supervisor on
pager #108 and report to Employee Health the next business day.
5. If evaluated in the Emergency Room for injuries or by the on-call STIX specialist, report or call the appropriate clinic the next business
day for further instructions. Refer to policies HSE004 for more information.
East Baltimore Campus: 7:30 AM – 4 PM (410)955-6433, Blalock 139. For emergency, call 5-4444 inside hospital. For
other East Baltimore Campus Buildings, call 911.
Bayview Campus: 8 AM-4:30 PM (410)550-0477, “A” Building. For emergency 0-0350 and/or 0-0222.
Homewood: 8:30 AM -5 PM (410)516-0450, Wyman Building, Room 603. For emergency, call (410)516-7777 (Security) and
they will call 911. Union Memorial Hospital will be utilized.
Howard Co. Hospital: 7:30 AM-4:30 PM (410)740-7838, TCAS Building 2
nd
Floor. For emergency, call (410)740-7777.
Suburban Hospital: 6:30 AM-5:00 PM M-F (301)896-3167 Employee Health on the second floor. After hours page the Nursing
Supervisor on pager #108. Report the injury before going to the Emergency Room.
Supervisors:
1. Supervisor should determine if the employee’s illness or injury on the job needs immediate medical attention as outlined in the “serious
injury/illness” section in this policy HSE004.
2. Complete an Employee Report of Incident, http://hopkinsmedicine.org/hse.stix.html. Retain a copy in the department. Employee
should bring the original copy to clinic.
3. If unable to complete and incident report at the time of injury, a call to the appropriate clinic is required to properly identify the
employee and department and provide a brief explanation of the incident. Forward the completed Employee Report of Incident form to
the Occupational Injury Clinic before the end of the shift.
4. If the employee reports an injury, illness or hazards but refuses to proceed to the designated campus clinic, document the employee’s
claim on the Employee Report of Incident. Write “Employee refused treatment” on the form and send it to the appropriate injury clinic.
5. Discuss the injury/illness with the employee to prevent recurrence, understand factors involved, and notify Safety if indicated.
JHH Form #15-1402020 (rev 7/13)