Frequently Asked Questions
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Risk Management Fund: Tort Incident Report
Q: What should be reported?
Q: What should I do when I am notified, witness, or am involved in an incident/accident?
Q: Which form(s) should be used to report incidents and accidents?
Q: Why is it important to use Risk Management's forms?
Q: Who should fill out a report of an incident/accident?
Q: When should the report forms be completed?
Q: How can I fill out an Incident Report if I did not see it happen?
Q: How can I fill out an Incident Report if someone does not report the event until days, weeks, or even months after it happened?
Q: What if the injured person wants to fill out the incident report form?
Q: Why is my role in preserving evidence so important?
Q: What if the potential claimant wants the agency to repair its damage immediately and/or ask for a commitment for payment?
Q: What should I do or say at the scene of an accident or when contacted for information about the incident/accident?
Q: How can I explain the State's liability coverage?
Q: How can I be sure Risk Management received the Incident Reports that I filed?
Q: Why do I have to waste my time double checking the filing of Incident Reports with the monthly loss runs sent by Risk Management?
Q: Where can I find my agency's Department Location Code?
Q: What is the difference between checking the Incident box and the Claim Form Requested box?
Q: What is the Destruction Hold Notice?
Q: What is needed to describe the location of the incident?
Q: How can I determine if an incident could have been prevented?
Q: Will "preventative action" be necessary for every incident?
Q: What all can I include in the general comments?
Q: Will the agency's contribution to the Risk Management Fund increase with the number of incident reports filed?
Q: What is different for reporting Workers Compensation incidents?
Q: What should be reported?
A: All incidents and accidents involving non-employees and employees, no matter how insignificant they seem. Such as:
- When someone has or claims to have been injured;
- When someone has or claims to have their property damaged; or
- When someone has or claims to have a monetary loss
Q: What should I do when I am notified, witness, or am involved in an incident/accident?
A: First, secure the situation. Do not endanger yourself or others.
Second, if necessary (such as if the person involved needs to leave the site), obtain the contact information and details from the persons involved. Information to collect includes:
- Names and roles of the people present;
- Equipment, vehicles, or other property involved, along with their placement and condition;
- Weather conditions and visibility;
- State of the general environment, including road surface, placement of signs, etc.
Third, notify your Risk Management Contact. The Contact will know the proper reporting procedures and the steps to implement necessary corrective actions. If the situation warrants, you may need to take corrective actions immediately.
Q: Which form(s) should be used to report incidents and accidents?
A:
- SFN 50508 for general incidents/accidents (i.e. slip and falls) and injuries to employees.
- SFN 51301 for accidents involving state fleet vehicle accidents.
The report forms can be completed and submitted on-line. If not filed on-line, the most current version of the paper forms can be accessed at www.state.nd.us/risk/forms/. The forms at this location are fillable on-line, but will need to be printed and filed with the Risk Management Division either by facsimile or mail.
Q: Why is it important to use Risk Management forms?
A: Incident reports, investigation reports, or other Risk Management Fund records of a pending or reasonably predictable claim against the state or a state employee are privileged and exempt from the open records law, pursuant to N.D.C.C. § 32-12.2-11. This means that only Risk Management has the authority to decide if these forms may be disclosed under an open records request while a matter is pending.
NOTE: The form will eventually become an open record, so you need to use your discretion when filling it out. It may be better to report some concerns you have verbally to the Risk Management Division rather than including those concerns on the written report.
It is important that any supporting documents (i.e. work orders for corrective action) or documents prepared regarding an incident/accident are attached to the Risk Management forms to secure the statutory protections.
Q: Who should fill out a report of an incident/accident?
A: The involved state employee with the most information about the incident/accident and the employee's supervisor, or the person with whom the injured person makes contact by phone or in person should complete the form. As the person involved, a witness, or the first one on the scene, you will have the crucial information to complete the initial Incident Report.
The Risk Management Contact will then submit or help submit the report.
Q: When should the report forms be completed?
A: Incidents involving serious injury (death, potential for death, or potential for serious or permanent injury) or extensive property damage should be reported immediately to 9-1-1 and to the Risk Management Division (701-328-7584).
All other incidents should be reported on-line to the Risk Management Division within 24 hours of the occurrence or notification.
Q: How can I fill out an Incident Report if I did not see it happen?
A:If you were the first person the potential claimant was in contact with after the incident occurred, even if you did not see it happen, you are the person with the most first-hand information and are in the best position to begin filling out the form. Plus, you have the opportunity to obtain more information. For example: if possible, go to the location of the incident to view the site; take pictures; note the weather; note the conditions of the area; identify witnesses, if any; implement corrective actions, if necessary. You are a key to preserving the evidence. (See FAQ on preserving evidence.)
Depending on the nature of the incident, you may need to gather more information from other employees in your entity to complete the report. For instance, reporting a slip and fall incident may involve contacting facilities personnel to obtain information about the snow and ice removal policies and procedures, including what procedures had been conducted that day. Therefore, completion of a report might require a joint effort between pertinent employees.
State only the facts, not opinions. You should not state what you “think” happened. Only document what the injured person told you and what you are able to verify (such as weather conditions or condition of the location).
Example:
“I did not see the incident. At 9:00 a.m., Jane Doe reported to me that she was walking to the east building entrance for an 8:30 am meeting and she slipped on a patch of ice on the sidewalk. I accompanied Jane to the area she identified as the location of the incident. I noted that the sidewalk was clear and dry. Pictures taken.” OR “I noted that the area was icy, but according to Facilities personnel, ice melt had been applied at 7:30 am.” OR “I noted that the area was icy and it didn’t appear that sand or ice melt had been applied.”
Q: How can I fill out an Incident Report if someone does not report the event until days, weeks, or even months after if happened?
A: Do the best that you can. Document what the potential claimant reported to you and note that you were not aware of the event until you received the recent report.
If the entity has records/documents/logs to verify or dispute the claim (i.e. we did not have equipment and crew at the location and time reported), please note and attach documentation.
Q: What if the injured person wants to fill out the incident report form?
A: The potential claimant should not be given the incident/accident forms to complete. The initial Incident and Accident Reports are intended to record the State’s full version and facts of how the incident happened. The potential claimant should be informed that a report will be filed with the Risk Management Division and a Notice of Claim form will then be mailed directly to them. The Notice of Claim form will give them an opportunity to tell their version and facts of the events.
Q: What is my role in preserving evidence so important?
A: A potential claimant has 180 days (approximately 6 months) to file a Notice of Claim form with the Risk Management Division. It is best to document all of the information you have while it is fresh in your mind. You may not be asked again about the incident until 6 months after it occurred and the details, if not the entire incident, may be forgotten.
The prompt reporting and preservation of evidence will also aid in the preparation and defense of a claim, as well as early resolution of a claim.
Q: What if the potenital claimant wants the agency to repair its damage immediately and/or ask for a commitment for payment?
A: Explain to the potential claimant that you and your entity do not have the authority to make that determination. Tell him/her that a report of the incident/accident will be forwarded to the Risk Management Division for processing. Refer the potential claimant to the Risk Management Division for questions (701-328-7584).
Q: What should I do or say at the scene of an accident or when contacted for information about the incident/accident?
A: Do not admit fault, liability, or negligence.
Exchange your general contact/identification and liability coverage information with the other party and law enforcement. You can inform the other party that a report of the incident will be filed with Risk Management and they will be contacted by Risk Management.
When discussing the matter, give only the facts, not opinions. Statements and more details can be provided to the entity’s Risk Management Contact, Risk Management Division, and attorneys for the State. Contact Risk Management before making statements or discussing the matter with anyone else, i.e. media, general public, insurance adjuster for other party, attorney for other party.
Do not put anything in writing other than what is required for the Incident Report, investigation materials, and other items approved by Risk Management!
Q: How can I explain the State's liability coverage?
A: You can tell other parties and/or law enforcement that liability coverage is the North Dakota Risk Management Fund, pursuant to N.D.C.C.ch. 32-12.2. There technically is not a policy number because the coverage is by statute, rather than an independent insurance company. State fleet vehicles should have an insurance card with this information in the packet given to the driver at checkout. See an example of the card below.
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Q: How can I be sure Risk Management received the Incident Reports that I filed?
A: An entity and its Risk Management Contact receive notice of incident reports filed with Risk Management in the following ways:
• When incident reports are submitted on-line, a notification e-mail, with the report attached, is automatically sent to the entity Risk Management Contact.
• Risk Management sends monthly claims and quarterly incident reports to the entity’s Risk Management Contact. If Risk Management has received the Incident Reports, the incidents will appear on the monthly loss run reports. The reports should be reviewed by the Contact and compared with the Incidents Reports submitted to Risk Management. If an incident is not on the monthly or quarterly loss run report, the Contact needs to notify Risk Management.
Q: Why do I have to waste my time double checking the filing of Incident Reports with the monthly loss runs sent by Risk Management?
A: Potential claimants have only 180 days from the date of their incident to file their official Notice of Claim with the Risk Management Division. If the reporting entity does not ensure that the Incident Reports have been received by Risk Management, the 180 day time period can lapse and the claimants may lose their opportunity to file a claim with the State for their loss.
Under these circumstances, if the claimant had a payable claim, this would be bad public policy and relations as there is no other statutory authority to pay such a claim. Therefore, the claim would be barred with no alternative for payment of the claimant’s losses.
Q: Where can I find my agency's Department Location Code?
A: A complete list of Department Location Codes can be found in Section 3 of the Risk Management Manual.
Q: What is the difference between checking the Incident box and the Claim Form Requested box?
A: When you only check the “Incident” box, you are telling Risk Management that the purpose of the report is to give notification of an incident, but Risk Management does not need to get in touch with the person involved and send him/her a Notice of Claim form.
When you check the “Claim Form Requested” box, you are telling Risk Management that a Notice of Claim form needs to be sent to the person involved because he/she indicated that they will be seeking compensation for the loss.
Q: What is a Destruction Hold Notice?
A: This gives immediate notification to Risk Management and the entity that any documents regarding the incident must be retained until Risk Management and legal counsel can determine the scope of the matter. This prevents any documents, records, or evidence related to an incident or claim from being destroyed and disposed of pursuant to a records destruction schedule.
Q: What is needed to describe the location of the incident?
A: Any information to identify the location with accuracy, including the street address, city, area (sidewalk, parking lot, east entrance), building name, distance from building, highway and mile marker, etc.
Q: How can I determine if an incident could have been prevented?
A: This gives the employee and his/her supervisor the opportunity to evaluate the incident, to review how it happened, and if something could have been done different. Some factors to consider are:
- Policies and procedures: which ones applied and were they being followed? If not, explain why?
- Do the policies and procedures need to be revised or updated?
- Is there a need for additional training?
- Is there an unsafe condition that needs to be corrected?
- Do inspections need to be done more often?
This involves a “factual” analysis, rather than based on opinions.
Q: Will "corrective action" be necessary for every incident?
A: No. There are incidents that are not preventable. However, the possibility should still be explored for every incident. It is also important to document and record whether preventative action was taken or not. Further, this automatically gives notification to Risk Management that the incident was addressed by the entity.
When corrective action is needed, it is a good practice to immediately complete a work order and attach a copy to the incident report.
Q: What all can I include in the general comments?
A: Any facts or additional information that you know about the incident. Diagrams may be applicable, if pictures are taken it can be noted here that they will be attached or e-mailed, the weather conditions that existed or conditions of the location (icy/slippery, wet, snow covered), observations about the potential claimant (running, slippery shoes, carrying large box), etc.
Example:
“ I did not see the incident, but I spoke with Jane Doe within ½ hour of her slipping on the sidewalk. She was wearing no-grip, high-heeled shoes. She told me . . . Attached you will find the pictures taken . . . “
Q: Will the agency's contribution to the Risk Management Fund increase with the number of incident reports filed?
A: No. Incident Reports are not a factor in determining an entity’s contribution amount. Incident reports are entered into a database to track trends and implement loss control procedures. Only when an incident turns into a claim, by the injured person filing a Notice of Claim form with the Risk Management Division, does it factor into an entity’s contribution amount.
Q: What is different for reporting Workers Compensation incidents?
A: Almost all of the same principles for Risk Management Fund reporting can also be applied to the Risk Management Workers Compensation program.
SFN 50508, Risk Management Fund Incident Report, can be used for reporting incident and accidents that result in minor injuries – injuries that do not require immediate medical treatment other than first aid. Completing and submitting this form on-line with Risk Management Workers Compensation serves as a record of notification to your employer in the event you require medical treatment in the future (up to one year). SFN 50508 should be submitted within 24 hours of receiving the report of injury.
For injuries requiring Medical Treatment, the Employee, needs to:
- Notify your entity Workers Compensation Contact;
- Complete SFN 50508 with your Supervisor/Workers Compensation Contact for filing with Risk Management;
- Complete SFN 2828 Sections 1 and 2 and file it electronically with Workforce Safety and Insurance;
- Obtain initial treatment from the pre-selected designated medical provider;
- Have care provider complete Section 3 and a Doctor's Report of Injury form (C3) each time you see your care provider during the acute phase of injury;
- Return C3 to supervisor or Workers Compensation Contact as soon as possible, but no longer than 24 hours after treatment.
For injuries requiring Medical Treatment, the Employee's Supervisor/Workers Compensation Contact needs to:
- Complete SFN 2828 Sections 1 and 4 and file it with Workforce Safety and Insurance within 24 hours from receipt of a copy of the Employee's Report of Injury; and
- Complete and submit on-line SFN 50508, Risk Management Incident Report Form, within 24 hours from receipt of a copy of the Employee's Report of Injury.
Traumatic Injuries require:
- Supervisor to immediately file the SFN 2828 and notify Risk Management by phone (328-7583); and
- Employee must complete SFN 2828 Section 2 as soon as possible thereafter.
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