Incidents, Accidents, and Policy for the Protection of Children (PFTPOC) Reports

🚨 Immediate / Emergency Situations
If you, a student worker, an employee or volunteer is injured on the job, if there is a serious incident, or a child who may be at immediate risk:

 📞 On Campus – Department of Public Safety (DPS)  508-793-2222
Contact DPS at 508-793-2222 for immediate medical assistance, to report an emergency, or to report suspected child abuse or neglect.

📞 Off Campus – Emergency Services -  Call 911
 for off-campus emergencies.

🏥 Medical Care (Non-Emergency)

👷 Employees: Seek non-emergency work-related medical care through  CareWell Urgent Care
🎓 Student Workers: For non-emergency injuries sustained while working, contact  Health Services  to schedule an appointment.

👔 Notify Your Supervisor
Inform your supervisor as soon as possible. Supervisors please complete your portion of this form.

📝 Complete the Injury / Incident 
This form is required for:

• Work-related injuries or illnesses (with or without medical care or lost time)
• Work-related incidents or near-incidents where no injury occurred

Note: This form uses skip logic, so you will only see questions relevant to your situation and/or role. It generally takes about 5–10 minutes to complete.

📩 Next Steps & Supporting Information

Reports are reviewed by Human Resources and Employee Health and Safety. A member of one of these teams may contact you to check in, gather additional information, and answer questions. 

• if helpful for understanding and applicable take detailed photos and/or videos of any hazards  email to: nhuizinga@holycross.edu and deveritt@holycross.edu 

• use the naming convention:

• Date of Incident_Last Name, First intial  -  identifier  attachment

• example: 11-09-25 Anderson  E – trip hazard photo

📊 Reporting Expectations 

Work-Related Injuries/Incidents

All work-related injuries or incidents with or without injury, regardless of severity, involving employees, volunteers, and student employees must be reported by both:

• 🧑 Injured Party: Report within 8 hours to meet OSHA regulatory requirements.
• 👔 Supervisor: Report on the same day you are notified, and no later than 24 hours after the incident.

All parties, including supervisors, are key partners in understanding, reviewing, and reducing hazards that may cause injuries, incidents, or potential claims.

📌 How Your Report Will Be Handled

• 💊 Lost Time or Medical Incidents: Human Resources will contact you with next steps, report the incident to workers’ compensation and is available to discuss leave/return-to-work guidance.
• ⚙️ Incidents With No Lost Time or Medical Care:  We understand this incident did not require medical care at this time. If medical attention becomes necessary now or in the future due to this incident,  please seek treatment at CareWell Urgent Care , and notify both your supervisor and Human Resources of any treatment you receive.  If circumstances change or you have additional information, submit an updated report and contact your Supervisor and HR. 

📇 Important Contact Information – 

Holy Cross Human Resources 

• General Email: HR@holycross.edu
  Fax: 508-793-3575

• Antonio Rocha, Benefits & HRIS Analyst
  Email: arocha@holycross.edu | Phone: 508-793-2424

• David Everitt, Director of Benefits
• Email: dbeveritt@holycross.edu | Phone: 508-793-2426

Human Resources reports injuries to the College’s workers’ compensation carrier. The HR team is available to assist with benefits, payroll, leave, and return-to-work questions.

🏢 Workers’ Compensation Insurer

ISCC Policy # WC 000329-26

Dedicated Claims Specialists 

Sharon Thomas
Future Comp for ISCC
Phone: 781-376-2704
Fax: 610-362-8463  

ISCC utilizes FutureComp for claims management. They can answer questions and coordinate with healthcare providers regarding your care and treatment. You are encouraged to share this information with anyone who needs it.

🧾 Other Reporting Options

⚠️ Good Catch / Near Miss / Notice Use this option to report a potential hazard or situation that did not result in injury but could have, so it can be addressed proactively.

📣 Make a Report  list other options for reporting other concerns. 

To submit a report anonymously, select  Make an Anonymous Report (EthicsPoint) 

 Contact:

👤David Everitt, Director of Benefits

✉️dbeveritt@holycross.edu | Phone: 508-793-2426