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Boise State Service-Learning Incident Report Procedure

**Reviewed by Boise State Office of Risk Management on November 22, 2005

A Service-Learning student involved in any unusual incident, agency staff, or agency client should complete the following documentation under the direct supervision of a faculty member.

Step 1

The student should write an accurate description of the event. This should be co-signed by the student as well as the faculty member observing the preparation of the report. The report should include:

  • Student name and contact information
  • Agency name, agency supervisor, and contact information
  • Faculty name, department, and contact information
  • Date and location of incident
  • Date reported to faculty
  • Synopsis of Incident

You may choose to use this Accident/Incident Report

Step 2

The report should be processed through regular channels of the agency.

Step 3

The faculty member should notify the Boise State Service-Learning Coordinator of the incident within 24 hours of the occurrence. The Service-Learning Coordinator will notify the Associate VP for Academic Affairs.

Step 4

Once the report has been completed, a copy of the report (with agency client information deleted) should be placed in the student’s file (kept by faculty) and the agency’s file (kept by the Service-Learning Program).

Step 5

The Service-Learning Coordinator will send a copy of the incident report to the BSU Risk Management and Insurance (RM&I) office at 1117 Denver St. Boise, Idaho 83725 -1240. Access the RM&I website here.

Should a student be injured or exposed while in the agency setting, the following procedure applies:

  1. The student will immediately notify the faculty member of the incident.
  2. The student will notify the agency staff responsible for the student in that agency.
  3. The student will follow the agency policy for reporting an injury or exposure, which may include completion of an incident or occurrence report, evaluation of the injury or exposure by the agency’s employee health service or emergency department.
  4. The faculty member will assist the student in reporting and accessing agency resources necessary for risk assessment, referral for screening, testing and/or treatment. The Service-Learning Coordinator can be contacted as a resource.
  5. The faculty and student will complete the previously listed Incident Report Procedure steps.

Note: some agencies will charge a fee for any testing or health care. If there is a fee for any services, the student will be responsible for the cost.

Adapted from
BOISE STATE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF NURSING
Student Handbook 2005-2006