{"id":26050,"date":"2024-09-17T16:11:24","date_gmt":"2024-09-17T21:11:24","guid":{"rendered":"https:\/\/sites.austincc.edu\/health\/?page_id=26050"},"modified":"2025-08-26T11:49:22","modified_gmt":"2025-08-26T16:49:22","slug":"accident-forms","status":"publish","type":"page","link":"https:\/\/sites.austincc.edu\/health\/facstaff\/accident-forms\/","title":{"rendered":"Accident Forms"},"content":{"rendered":"<p>[vc_row][vc_column width=&#8221;1\/6&#8243; css=&#8221;.vc_custom_1557156181353{margin-bottom: 20px !important;padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 0px !important;padding-left: 0px !important;}&#8221; el_class=&#8221;left-column-events&#8221; offset=&#8221;vc_hidden-sm vc_hidden-xs&#8221;][vc_column_text]<\/p>\n<h2 style=\"text-align: center\">Upcoming Events<\/h2>\n<p>[\/vc_column_text][vc_column_text css=&#8221;.vc_custom_1557156141295{background-color: #ffffff !important;}&#8221;][calendar id=&#8221;10527&#8243;]<\/p>\n<p style=\"text-align: center\"><a href=\"https:\/\/sites.austincc.edu\/health\/events\/\">Click here to see all Upcoming Events<\/a><\/p>\n<p>[\/vc_column_text][\/vc_column][vc_column width=&#8221;7\/12&#8243; el_class=&#8221;right-column&#8221; css=&#8221;.vc_custom_1726609004162{margin-bottom: 20px !important;margin-left: 7px !important;background-color: #ffffff !important;}&#8221; el_id=&#8221;primary-section&#8221;][vc_column_text css=&#8221;.vc_custom_1726606987154{margin-bottom: 20px !important;}&#8221;]<\/p>\n<h1 style=\"text-align: center\">Accident Forms<\/h1>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h2>Faculty\/Staff Injury and Illness Claims<\/h2>\n<ul>\n<li><a href=\"https:\/\/docs.google.com\/forms\/d\/1N9EMD_eGNUE-jYbU3XL4me2zxZ0qucBK-uBHY0_esJY\/edit\">Incident Reporting Form<\/a>\u00a0\u2013\u00a0<em><strong>Handwritten forms are no longer accepted.\u00a0<\/strong><\/em>You must use a PDF editor such as Adobe Reader to complete this form.<\/li>\n<li><a href=\"https:\/\/offices.austincc.edu\/risk-management\/workers-compensation\/\" target=\"_blank\" rel=\"noopener\">Workers\u2019 Compensation Insurance<\/a><\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h2>Student Accident Procedures<\/h2>\n<ol>\n<li>Provide injured student the appropriate triage and first aid.<\/li>\n<li>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:\n<ol>\n<li><b>Inform Student:<\/b> they may seek treatment from a primary care provider (PCP), a minor emergency center, or be transported to a hospital.<\/li>\n<li><b>Complete Immediately:<\/b><a href=\"https:\/\/docs.google.com\/forms\/d\/e\/1FAIpQLSd90THnolTEQtnRTmFCfStt-On23PYIkOxmtaq6bSs2iBk-1g\/viewform\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/docs.google.com\/forms\/d\/e\/1FAIpQLSd90THnolTEQtnRTmFCfStt-On23PYIkOxmtaq6bSs2iBk-1g\/viewform&amp;source=gmail&amp;ust=1726593783512000&amp;usg=AOvVaw1vJScRpPTlweEXnFHj7J7D\">\u00a0ACC Student Accident Insurance Form<\/a>\u00a0\u2013 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 (<a href=\"mailto:accriskmgmt@austincc.edu\" target=\"_blank\" rel=\"noopener\">accriskmgmt@austincc.edu<\/a> ).<\/li>\n<li><b>Notify Campus Police:<\/b> as soon as possible that an accident occurs on campus in order to include the incident in the daily report for the campus.<\/li>\n<li><b>Complete within 24 hours: <\/b><a href=\"https:\/\/docs.google.com\/forms\/d\/1N9EMD_eGNUE-jYbU3XL4me2zxZ0qucBK-uBHY0_esJY\/viewform?edit_requested=true\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/docs.google.com\/forms\/d\/1N9EMD_eGNUE-jYbU3XL4me2zxZ0qucBK-uBHY0_esJY\/viewform?edit_requested%3Dtrue&amp;source=gmail&amp;ust=1726593783512000&amp;usg=AOvVaw0UlWM6JtVZp15o9varNMe1\">Injury\/Incident Reporting Form<\/a> \u2013 this digital form is required to inform Safety Environmental Management (SEM) of a potential safety concern for review and annual reporting.<\/li>\n<\/ol>\n<\/li>\n<li>The student\u2019s 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\u2019s insurance company. The student will need to know an emergency phone number and email for their instructor.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h2>Infectious Disease Exposure Response<\/h2>\n<div id=\"accident-forms\" class=\"vc_tta-panel vc_active\" data-vc-content=\".vc_tta-panel-body\">\n<div class=\"vc_tta-panel-body\">\n<div class=\"wpb_text_column wpb_content_element \">\n<div class=\"wpb_wrapper\">\n<p>Students and faculty members who experience an exposure to any potentially infectious materials (needle stick, mucous membrane, or non-intact skin) or airborne inhalation require specific follow-up. It is the responsibility of the individual to initiate appropriate first aid and to report the incident as soon as possible (preferably\u00a0<strong><u>within one<\/u><\/strong><u>\u00a0<strong>hour<\/strong>)<\/u>\u00a0to their immediate supervisor, clinical preceptor, or instructor. It is the responsibility of the clinical and\/or lab faculty or supervisor to ensure that the appropriate steps have been taken to provide for the safety of the student. It is the responsibility of the Department Chair to assist the faculty member following an exposure to the student or employee. Faculty will ensure that copies of the accident exposure procedures and appropriate forms will be made available to the students prior to their first clinical experience.<\/p>\n<p>If a student or faculty member is notified of a possible COVID-19 exposure at a clinical site, they should follow the procedures of the clinical facility and the <a href=\"https:\/\/www.cdc.gov\/covid\/hcp\/infection-control\/index.html\">CDC\u2019s Infection Control Guidance<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"referrals\" class=\"vc_tta-panel\" data-vc-content=\".vc_tta-panel-body\">\n<div class=\"vc_tta-panel-heading\">\n<h4 class=\"vc_tta-panel-title vc_tta-controls-icon-position-right\"><\/h4>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/4&#8243;][vc_column_text]<\/p>\n<h2 style=\"text-align: center\">Search the Health Sciences Website<\/h2>\n<p>[\/vc_column_text][vc_raw_html el_class=&#8221;search-box&#8221; css=&#8221;.vc_custom_1563825898678{margin-bottom: 0px !important;border-bottom-width: 0px !important;padding-bottom: 0px !important;background-color: #ffffff !important;}&#8221;]JTNDc2NyaXB0JTIwYXN5bmMlMjBzcmMlM0QlMjJodHRwcyUzQSUyRiUyRmNzZS5nb29nbGUuY29tJTJGY3NlLmpzJTNGY3glM0QwMDM3NzAzNDE0NjUyNjUyNzczNjMlM0FkMzNieWhkNGF1OCUyMiUzRSUzQyUyRnNjcmlwdCUzRSUwQSUzQ2RpdiUyMGNsYXNzJTNEJTIyZ2NzZS1zZWFyY2glMjIlM0UlM0MlMkZkaXYlM0U=[\/vc_raw_html][vc_column_text]<\/p>\n<h2 align=\"center\">Health Sciences Updates<\/h2>\n<p>[\/vc_column_text][vc_column_text]<ul class=\"lcp_catlist\" id=\"lcp_instance_0\"><li><h4 class=\"lcp-title\">Study Abroad Opportunity for RN-to-BSN Students &#8211; Spring 2027<\/h4><p class=\"lcp-excerpt\">RN-to-BSN students have the opportunity to complete NURS 4160 through a faculty-led study abroad experience in Costa Rica during Spring 2027.<\/p><a href=\"https:\/\/sites.austincc.edu\/health\/updates\/study-abroad-opportunity-for-rn-to-bsn-students\/\" class=\"read-more\">Read more<\/a><\/li><li><h4 class=\"lcp-title\">General Health Sciences Information Sessions<\/h4><p class=\"lcp-excerpt\">These sessions are presented by Health Sciences Faculty Advisors and provide an overview of the health training options available at the college, the steps needed to apply and the expectations for success.<\/p><a href=\"https:\/\/sites.austincc.edu\/health\/updates\/general-health-sciences-information-sessions\/\" class=\"read-more\">Read more<\/a><\/li><li><h4 class=\"lcp-title\">Bats to Cats Transfer Program<\/h4><p class=\"lcp-excerpt\">Start at ACC and transfer seamlessly to Texas State University! If you are pursuing a Bachelor's degree, get the details on admissions requirements, deadlines, and financial support.<\/p><a href=\"https:\/\/sites.austincc.edu\/health\/updates\/bats-to-cats\/\" class=\"read-more\">Read more<\/a><\/li><\/ul><ul class='lcp_paginator'><li class='lcp_currentpage'>1<\/li><li><a href='https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages\/26050?lcp_page0=2#lcp_instance_0' title='2'>2<\/a><\/li><li><a href='https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages\/26050?lcp_page0=2#lcp_instance_0' title='2' class='lcp_nextlink'>&gt;&gt;<\/a><\/li><\/ul>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column width=&#8221;1\/6&#8243; css=&#8221;.vc_custom_1557156181353{margin-bottom: 20px !important;padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 0px !important;padding-left: 0px !important;}&#8221; el_class=&#8221;left-column-events&#8221; offset=&#8221;vc_hidden-sm vc_hidden-xs&#8221;][vc_column_text] Upcoming Events [\/vc_column_text][vc_column_text css=&#8221;.vc_custom_1557156141295{background-color: #ffffff !important;}&#8221;][calendar id=&#8221;10527&#8243;] Click here to see all Upcoming Events [\/vc_column_text][\/vc_column][vc_column width=&#8221;7\/12&#8243; el_class=&#8221;right-column&#8221; css=&#8221;.vc_custom_1726609004162{margin-bottom: 20px !important;margin-left: 7px !important;background-color: #ffffff !important;}&#8221; el_id=&#8221;primary-section&#8221;][vc_column_text css=&#8221;.vc_custom_1726606987154{margin-bottom: 20px !important;}&#8221;] Accident Forms [\/vc_column_text][vc_column_text] Faculty\/Staff Injury and Illness Claims Incident Reporting Form\u00a0\u2013\u00a0Handwritten [&hellip;]<\/p>\n","protected":false},"author":4282,"featured_media":0,"parent":1297,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-26050","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages\/26050","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/users\/4282"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/comments?post=26050"}],"version-history":[{"count":0,"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages\/26050\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/pages\/1297"}],"wp:attachment":[{"href":"https:\/\/sites.austincc.edu\/health\/wp-json\/wp\/v2\/media?parent=26050"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}