Article Structure
The Pod 265 E form plays a vital role in reporting accidents within projects overseen by the U.S. Army Corps of Engineers, particularly in the Pacific Ocean Division. This form is utilized to document essential details surrounding an incident, including the nature of the accident, the individuals involved, and any resulting injuries or property damage. Individuals reporting the accident must provide information such as their contact details, the specifics of the event, and what occurred before the incident took place. The form also includes sections for detailing the medical treatment required, the estimated days away from work, and whether an investigation is necessary. If certain criteria are met, including severe injuries or significant property damage, additional notifications and reports must be completed. By ensuring all pertinent information is accurately captured, the Pod 265 E form assists in maintaining workplace safety and compliance with federal regulations.
Pod 265 E Example
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U.S. ARMY CORPS OF ENGINEERS, PACIFIC OCEAN DIVISION HEADQUARTERS
IMMEDIATE REPORT OF ACCIDENT
For use of this form, see EM
SOHO USE ONLY
DATE RECORDED |
TIME RECORDED |
TO (COE OFFICE): |
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FROM: |
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1. NAME OF PERSON REPORTING ACCIDENT |
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1a. PHONE NO. |
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2. ACCIDENT INFORMATION (CHECK ALL THAT APPLY): |
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INJURY |
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INITIAL REPORT |
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CONTRACTOR |
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PROPERTY DAMAGE |
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ILLNESS |
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FOLLOW UP REPORT* |
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GOVERNMENT |
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OTHER (explain) |
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FATALITY |
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FINAL REPORT |
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PUBLIC |
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*A follow up report is due within 24 hours of any changes or additional information related to the accident (e.g., workers duty status)
3. CONTRACTOR/SUBCONTRACTOR |
3a. CONTRACT NO. |
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4. LOCATION OF ACCIDENT (be specific, include project name and number) |
4a. DATE OF ACCIDENT |
4b. TIME OF ACCIDENT |
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5. NAME OF PERSON INVOLVED/INJURED (Last name, First name)
5a. AGE
5b. OCCUPATION
6.What was the activity before the accident occurred? Describe the activity, as well as the tools, equipment, or materials the employee was using (e.g., excavating with a backhoe, electrical equipment installation, demolition of facility, erecting structural steel):
7.What Happened? Tell how the injury, illness, or property damage occurred (e.g., struck by, contacted by, cut by, strained by, fell from same or different level, stung by):
8.What was the injury, illness or property damage (e.g., contusion, bruise, muscle strain, fracture, respiratory, allergic reaction, skin disease, poisoning, collapsed crane boom, engine fire, damaged utilities)?
9.Is the injury, illness, or property damage recordable as defined in OSHA 29 CFR Part 1904 or ER
beyond first aid, loss of consciousness or other significant illness. Property damage of $2000.00 or more is recordable. |
Yes |
No |
10.What medical treatment was required for the injury or illness (e.g., first aid, sutures, prescription medication,
11.If medical treatment was given away from the work site, where was it given?
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Was employee hospitalized overnight as an |
13. Estimated days away from |
13a. Estimated Job Transfer or |
13b. Estimated days |
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Yes |
No |
work: |
Restricted Days: |
hospitalized: |
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Did accident result in property damage? |
16. If yes, estimated property damage (if property damage is $2000 or greater ENG Form 3394 |
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Yes |
No |
must be completed and submitted) |
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17. |
**Accident Board of Investigation Required? |
17a. If yes, was immediate notification to the designated authorities made? District Safety Officer |
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Yes |
No |
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and Commander must be notified of all serious cases. |
Yes |
No |
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**A board of investigation is required if the the accident results in: A. a fatality, B. three or more people admitted to the hospital, C. permanent total or partial disability, or D. property damage of $500,000 and greater.
18. NAME AND TITLE OF INDIVIDUAL WHO WILL INVESTIGATE THIS ACCIDENT
NAME AND TITLE OF PERSON REPORTING
PHONE:
SIGNATURE
DATE
POD FORM |
THIS FORM REPLACES POD |
Page 1 of 2 |
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CONTINUATION PAGE
POD FORM |
Page 2 of 2 |
Form Characteristics
| Fact Name | Details |
|---|---|
| Purpose | This form is used to report accidents involving employees of contractors working on U.S. Army Corps of Engineers projects. |
| Governing Law | The use of this form is governed by EM 385-1-1 and OSHA regulations. |
| Reporting Timeline | A follow-up report must be submitted within 24 hours if any changes occur regarding the accident. |
| Recordable Injuries | Injuries are considered recordable if they lead to death or require medical treatment beyond first aid. |
| Medical Treatment | The form asks for details on what medical treatment, if any, was required after the accident. |
| Investigation Requirement | An accident board investigation is needed for serious cases like fatalities or significant property damage. |
| Data Collection | Information about the accident, location, and individuals involved must be documented for proper evaluation and record-keeping. |
Guidelines on Utilizing Pod 265 E
Once you have gathered all the necessary information, the next step is to complete the Pod 265 E form accurately. Ensure each section is filled out based on the particulars of the accident being reported. This form must be submitted to the appropriate authorities for record-keeping and to facilitate necessary follow-up actions.
- Locate the form titled "Pod 265 E" which is specifically for reporting accidents.
- Fill in the DATE RECORDED and TIME RECORDED at the top of the form.
- Indicate the COE OFFICE you are reporting to and provide your details in the FROM section.
- In section 1, enter your NAME and PHONE NUMBER.
- For section 2, select all relevant options under ACCIDENT INFORMATION, such as injury, property damage, or illness.
- In section 3, note the CONTRACTOR/SUBCONTRACTOR along with the CONTRACT NUMBER.
- Section 4 requires you to specify the LOCATION OF ACCIDENT, DATE, and TIME.
- Enter the NAME of the person involved or injured in section 5, along with their AGE and OCCUPATION.
- Clearly describe the activity taking place before the accident occurred in section 6.
- Explain what happened in section 7, detailing the specifics of the incident.
- Document the injury or damage in section 8, providing clear descriptions.
- In section 9, ascertain if the incident is recordable according to the applicable regulations.
- Detail the medical treatment required in section 10, including any specifics.
- If medical treatment was necessary away from the site, indicate where it was given in section 11.
- In section 12, confirm if the employee was hospitalized overnight.
- Estimate the days away from work and record any job transfers or restricted days in section 13.
- Section 15 requires you to indicate if there was property damage.
- If there was property damage, provide an estimate in section 16.
- In section 17, determine if a board of investigation is required and note any immediate notifications made.
- Finally, in section 18, provide the name and title of the individual who will investigate the matter, as well as your name, title, contact number, and signature with the date.
What You Should Know About This Form
What is the purpose of the Pod 265 E form?
The Pod 265 E form is used by the U.S. Army Corps of Engineers to immediately report accidents that occur at work sites. It is essential to capture details about the incident, including the nature of the accident, the individuals involved, and any resulting injuries or property damage. This helps ensure that accidents are documented properly and allows for timely investigations and follow-up actions to promote workplace safety.
Who is required to fill out the Pod 265 E form?
The form is typically completed by the person who witnesses or is involved in the accident. This may include a supervisor, a safety officer, or the injured party themselves. It is crucial that the individual reporting the accident provides as much detail as possible to ensure accuracy and clarity for the appropriate authorities.
What information is needed to complete the form?
To fill out the Pod 265 E form, you will need to provide various details such as your name and contact information, specifics about the accident (time, date, location), the names and ages of those involved, a description of the activity that led to the accident, and details regarding any injuries or property damage. Additionally, it is important to indicate whether the incident is considered recordable according to OSHA standards.
What should I do if I need to submit a follow-up report?
If circumstances change or additional information becomes available after the initial report is filed, a follow-up report is necessary. This must be submitted within 24 hours of the initial report. Make sure to update all relevant details, such as changes in the injured person's duty status or new information regarding the accident.
Is there a requirement for medical treatment documentation after an accident?
Yes, if medical treatment is provided for an injury or illness resulting from the accident, details about the treatment must be included in the report. This includes the type of medical care received, where it occurred, and whether the employee required hospitalization. Keeping accurate medical records is crucial for both reporting and treatment purposes.
What determines if an investigation board is required following an accident?
An accident investigation board is necessary if certain conditions are met, such as a fatality, hospitalization of three or more individuals, permanent disability, or property damage exceeding $500,000. In these cases, notifying the designated authorities, including the District Safety Officer and Commander, is essential for compliance and thorough investigation.
How can I ensure accurate reporting on the Pod 265 E form?
To ensure accurate reporting on the Pod 265 E form, provide clear and detailed descriptions of the incident and any resulting injuries. Double-check all information for completeness before submission. Collaborating with coworkers who were present during the accident can also help gather additional insights to enrich the report. Accuracy is vital, as it not only affects compliance but also contributes to improving safety measures in the workplace.
Common mistakes
Filling out the Pod 265 E form requires attention to detail. One common mistake individuals make is not providing complete accident information. When detailing the incident, it’s crucial to include specifics. All relevant information about the accident should be checked off properly, such as whether an injury, illness, or property damage has occurred. Omitting these details can hinder the accuracy of the report.
Another frequent error is inaccurate or incomplete description of the accident location. It is essential to specify not just the location but also the project name and number. Failure to do so can lead to confusion, especially in cases where multiple projects are ongoing. A vague description diminishes the effectiveness of the report.
Many individuals neglect to report proper medical treatment details. Section 10 of the form requires a clear explanation of the type of medical care received following the incident. If this information is vague or incomplete, it can complicate further medical attention for the injured party as well as potentially affect worker’s compensation claims.
Individuals often overlook the need to check the recordability of the injury or property damage according to OSHA standards. Not marking this correctly in question 9 can have significant repercussions. This oversight can result in missed deadlines for additional reporting, creating further complications.
Another significant mistake lies in not completing the follow-up report. If changes occur after the initial report submission, a follow-up report is required within 24 hours. Ignoring this responsibility could lead to an incomplete record of the incident and may affect any investigations or claims.
Finally, some individuals mistakenly leave out crucial information regarding the investigator. The section for the individual's name and title who will investigate the accident needs to be completed thoroughly. Incomplete details here can cause delays in necessary investigations and follow-up actions, jeopardizing the safety protocols that need to be established after an incident.
Documents used along the form
The Pod 265 E form is a crucial document within the U.S. Army Corps of Engineers for reporting accidents. It ensures that all necessary details surrounding an accident are meticulously recorded. However, it often accompanies other documents that provide further context or facilitate follow-up actions. Below is a list of related forms and documents that may be utilized in conjunction with the Pod 265 E form.
- ENG Form 3394: This form is essential when an injury or property damage meets the recordability criteria set forth by OSHA. It must be submitted within ten days and provides detailed information about the incident.
- Incident Report: Typically required for internal reporting, this document outlines the specifics of the accident and ensures that all organization protocols are adhered to. It offers a comprehensive account of the events leading up to the incident.
- Medical Release Form: Should medical treatment be provided, obtaining a medical release form is vital. This document ensures that medical professionals are authorized to share relevant information about the injured party with those responsible for the investigation.
- Accident Investigation Report: If an accident board of investigation is necessary, this report compiles findings from the investigation to analyze the causal factors and make recommendations to prevent future incidents.
- Follow-Up Report: A follow-up report is due within 24 hours of any changes or additional information regarding the accident. It is necessary if there are updates about the injured party's status or new damages discovered.
- Safety Meeting Notes: Documenting discussions about the occurrence in subsequent safety meetings is important for reinforcing safety protocols and addressing any employee concerns regarding workplace safety.
Providing these documents in conjunction with the Pod 265 E form creates a robust framework for addressing workplace accidents effectively. It supports not only legal compliance but also demonstrates a commitment to employee safety and well-being.
Similar forms
The POD Form 265 E, used by the U.S. Army Corps of Engineers for reporting accidents, shares similarities with several other key documents designed for similar purposes. Below is a list detailing these comparable forms:
- Incident Report Form: Similar in structure, it collects detailed information about workplace incidents, including the nature of the accident and the individuals involved. Both forms aim to ensure all pertinent data is recorded for evaluation and action.
- Safety Inspection Report: This document focuses on identifying potential hazards and ensuring compliance with safety standards. Like the POD Form 265 E, it serves to improve workplace safety by documenting conditions and recommending actions.
- OSHA 300 Log: Used for tracking work-related injuries and illnesses, much like the POD Form, it requires detailed record-keeping to ensure compliance with occupational safety regulations.
- First Report of Injury (FROI): This document is similar in format and purpose, as it records the initial information regarding a workplace injury, thereby starting the claims process for workers' compensation.
- Accident Investigation Report: Focused on evaluating the causes and repercussions of an accident, it parallels the POD Form in its objective to identify and mitigate risks to prevent future occurrences.
- Property Damage Report: This form surveys details related to any damage caused to property as a result of an accident. Much like the injury report portions of the POD Form, it highlights important assessment criteria following an incident.
- Medical Treatment Report: While more focused on the health aspects, this document records the type of medical treatment recipients received after an incident, complementing the medical treatment inquiries found in the POD Form 265 E.
Dos and Don'ts
When filling out the Pod 265 E form, there are important guidelines to follow for accuracy and clarity. Here’s a list of do's and don'ts to consider:
- Do provide complete and accurate contact information for the person reporting the accident.
- Do check all applicable boxes under accident information. This helps in clearly categorizing the incident.
- Do include specific details regarding the location of the accident, such as the project name and number.
- Do describe the activity leading up to the accident, noting any tools or equipment being used.
- Do indicate whether any medical treatment was provided and where it occurred.
- Don't omit details about the nature of the injury, illness, or property damage. Be as specific as possible.
- Don't neglect to note if an accident board of investigation is required, as this could be crucial for serious incidents.
- Don't forget to submit the follow-up report within 24 hours if there are changes in information.
- Don't leave blank any section that can be reasonably filled out. Complete every relevant field to avoid delays.
- Don't assume that someone else will provide the details. Take responsibility for ensuring the report is thorough.
Misconceptions
Misunderstandings about the Pod 265 E form are common. Here’s a list of ten misconceptions along with clarifications to help clear up any confusion.
- It's only for serious accidents. Many believe that this form is only necessary for major incidents. However, it must be filed for any accident, regardless of severity, if there’s an injury, illness, or property damage.
- Follow-up reports are optional. Some think that follow-up reports are not mandatory. In reality, if there are any changes or additional information related to the accident, a follow-up report is required within 24 hours.
- The form is only for government employees. Many assume that only government employees can report using this form. In fact, contractors and subcontractors must report incidents as well.
- Property damage doesn't need to be reported. A misconception exists that minor property damage doesn’t require a report. However, any damage costing $2,000 or more must be documented.
- Injuries must be severe to be recordable. Some people think only serious injuries count as recordable. In fact, injuries leading to any medical treatment beyond first aid can make a case recordable.
- Medical treatment details aren’t necessary. Some individuals believe that it’s not important to include medical treatment on the form. On the contrary, detailing any medical care received is crucial for proper documentation.
- You can submit the form anytime. There’s a notion that there's no rush to file the form. However, it's best to submit it as soon as possible to ensure timely communication.
- Only one person can report an accident. Some think that the accident can only be reported by a single person. However, anyone can report an incident, not just those directly involved.
- The form is only for accidents. Some people incorrectly believe that this form is solely for accidents. The form can also be used for illnesses that arise from workplace conditions.
- The investigation process is informal. A common misconception is that reporting an accident is a casual affair. In reality, a formal investigation may be required following certain serious incidents.
Understanding these misconceptions can help ensure that the Pod 265 E form is used correctly, promoting accountability and safety in the workplace.
Key takeaways
Here are key takeaways regarding the completion and utilization of the Pod 265 E form, a document for reporting accidents within the U.S. Army Corps of Engineers:
- The Pod 265 E form is designed for immediate reporting of accidents, injuries, or property damage related to Army Corps operations.
- The form must be submitted to the appropriate Corps of Engineers (COE) office as soon as possible following the incident.
- Accident reporting is categorized into several types, including injury, illness, property damage, and fatality.
- A follow-up report is necessary within 24 hours if there are any changes or additional information regarding the accident.
- Each entry requires specific information, such as the name and contact information of the person reporting the accident.
- Details about the accident must include the location, date, time, and a description of what happened.
- Identifying the activity prior to the accident is crucial for understanding context, including tools and equipment involved.
- Medical treatment information should specify what was necessary, such as first aid or hospitalization.
- Determining if the incident is recordable as defined by OSHA guidelines is essential for compliance; certain criteria trigger additional reporting forms.
- In cases of severe accidents, an accident board of investigation may be required and must be coordinated with designated authorities.
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