Faculty/Staff Injury and Illness Claims

• Incident Reporting Form – Handwritten forms are no longer accepted. You must use a PDF editor such as Adobe Reader to complete this form.
• Workers’ Compensation Insurance

Student Accident Procedures

1. Provide injured student the appropriate triage and first aid.
2. The accident occurring in the clinical area requires the faculty member responsible for the course and the faculty member will need to complete following steps:
   1. Inform Student: they may seek treatment from a primary care provider (PCP), a minor emergency center, or be transported to a hospital.
   2. Complete Immediately: ACC Student Accident Insurance Form – this digital form must be completed by a faculty member on behalf of an injured student to verify coverage. When the form is submitted, instructions and the insurance card needed by the student to receive care will automatically be emailed to the student, and ACC Risk Management ([email protected] ).
   3. Notify Campus Police: as soon as possible that an accident occurs on campus in order to include the incident in the daily report for the campus.
   4. Complete within 24 hours: Injury/Incident Reporting Form – this digital form is required to inform Safety Environmental Management (SEM) of a potential safety concern for review and annual reporting.
3. The student’s personal health care insurance will be used as primary coverage for the accident, while ACC Student Accident Insurance will serve as secondary coverage to reduce out-of-pocket costs to $25.00, up to a maximum of $25,000. Secondary coverage claims require a one-time $25.00 deductible to be paid by the student. The student may either assign insurance benefits directly to the provider or pay the bill at the time of treatment and then request reimbursement from ACC’s insurance company. The student will need to know an emergency phone number and email for their instructor.

Infectious Disease Exposure Response