All incidents which occur at UPEI need to be reported using the Incident Reporting Form. The report can be completed by anyone who knows the details of the incident.This can include the affected party, their Supervisor, or the employee that the incident was reported to (if a visitor). If you witness an incident, please complete the Incident Witness Statement.

An Anonymous Incident Report may be submitted. An Anonymous Incident Report will be investigated according to the information provided to the best of the Investigator’s ability. No feedback will be provided to the submitter.

Incident reports with respect to matters that fall under the Fair Treatment Policy will be referred to the Fair Treatment Advocate.

The Health, Safety, and Environment department needs to obtain an incident report for each incident within 24 hours of the incident occurring. All forms can be submitted via email to incident@upei.ca or in-person to Kelley Memorial Building, Room 117. A drop box is located outside Room 117 for after-hour submissions.

Please note all serious incidents should be immediately reported to Security Services by calling (902) 566-0384.

​If injured, the worker, student visitor, etc., shall:

1. Seek medical attention and/or first aid immediately. All serious injuries should be immediately reported to UPEI Security 902-566-0384.

If you are not a UPEI paid worker:

1. Complete an Incident Report Form and give to a UPEI staff member who will ensure the UPEI Risk Manager receives it to follow up with you.

If you are a UPEI paid worker:

1. Fill out the Incident Report Form and provide it to your Supervisor immediately. Supervisor investigation tools and report should be completed by the Supervisor to identify and implement corrective actions (immediate or permanent) to prevent a recurrence. The Incident Reporting: Supervisor Responsibilities protocol provides information on what is meant by a minor and major injury incident, and the specific requirements that must be met once an incident has occurred.

2. If medical attention beyond first aid is required, submit a completed Form 6 to the Worker’s Compensation Board (WCB) PEI immediately. The Physician’s Report – Form 8 will be completed by the treating Physician and submitted to WCB PEI.

3. UPEI will submit an Employer’s Report of Injury – Form 7 to WCB PEI within 72 hours of being notified by the injured worker.

4. If the work-related injury/illness exceeds the day of injury/illness, please contact the Health, Safety and Environment Department (902-566-0516) or Human Resources personnel (902-566-0514).

5. After seeking medical attention for a workplace injury the worker must inform and work with their employer to establish an early and safe return to work (ESRTW) plan within medically substantiated limitations and restrictions.

6. UPEI will provide ESRTW plan within the limitations and restrictions provided by your Physician (when possible).

What would be considered an incident?

• Incident Report
• Anonymous Incident Report
• Incident Witness Statement
• Worker’s Report – WCB Form 6
• Physician’s Report – WCB Form 

Supervisor Forms:

• Incident Investigation Form
• Three Point Risk Ranking Scheme and Ranking Matrix
• Root Cause Analysis Form – 5 whys
• UPEI Incident Report Supervisory Responsibilities

Serious Injury Reporting

• Serious Injury Report Form
• Serious Injury Witness Statement
• Serious Injury Investigation Form
• Root Cause Analysis Form – 5 whys

Right to Refuse Unsafe Work Reporting

• Right to Refuse Unsafe Work Form
• Work Refusal Flow Chart

Contact

Liz Rostant-MacArthur, BSc, MSc

Health, Safety, and Environment Manager

Email: hse@upei.ca

Phone: 902-566-0516