Incident/Accident and Near-Miss Reporting Procedures and Forms

All incidents, accidents or near-misses should be reported to Safety and Risk Management and County Counsel on the reporting forms below:

Vehicle Accident Report Forms:

SRM 1 - Accident Procedure Checklist

SRM 2 - Third Party Accident Information Request Form

SRM 3 - County Accident Information Request Form

SRM 4 - Collision Report

SRM 5 - Supervisor’s Investigation of Incident Report

Incident/Accident Forms:

Employee Injury Reporting Flow Chart

801 Form - Workers Compensation Claim Form

Release to Return to work

SAIF Training: How to use MEEE & 801 Forms

SRM 6 - County Incident/Accident Analysis "MEEE" Form

SRM 7 - Near-miss Reporting Form

Vehicle accidents must be returned to County Counsel’s Office (no later than noon the next day)

Fax to: (541) 396-1012

Hand Delivered to: Counsel's Office 225 N Adams, Coquille, OR 97423

Fatal Injuries must be reported to Human Resources, Immediate Supervisor and OSHA (within 8 hours)

Phone: (541)396-7580