The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995: Guidance for employers in the healthcare sector

CONTENTS

Who should report?

Employers, the self-employed and those in control of work premises have duties under the Regulations.

The duty to notify and report rests with the 'responsible person'. This may be the employer of an injured person, a self-employed person, or someone in control of premises where work is carried out. Who the responsible person is depends on the circumstances of the notifiable event as shown in Table 1.

Accidents

'Accidents' include acts of physical violence to people at work, but not violence to other people, such as patients or visitors.

You do not need to report accidents arising directly from the conduct of an operation, examination or other medical treatment, carried out or supervised by a doctor or dentist.

For an accident to be reportable it must arise 'out of or in connection with' work. Accidents which arise solely from the condition of the injured person are not reportable, neither are suicides.

Table 1
Reportable event	Injured person	Responsible person
Death, major injury, over-3-day injury or disease	Employee at work	Employer
Death, major injury or over-3-day injur	A self-employed person at work in premises controlled by someone else	Person in control of the premises
Major injury, over-3-day injury or case of disease	A self-employed person on their own premises	Self-employed person or someone acting on their behalf
Death, or reportable injury	A person not at work	Person in control of the premises
Dangerous occurrence		Person in control of the premises

Examples: Reportable accidents

Reportable

• A confused patient falls from a window on an upper floor and is badly injured.
• A hospital patient is scalded by hot bath water and has to be moved to a burns unit for treatment.

Not reportable

• A frail elderly woman falls and breaks her leg, there are no obstructions or defects in the premises which contributed to the fall.
• A patient commits suicide.

Death or major injuries

You need to report the following accidents connected with work:

• Your employee (wherever they are working), or a self-employed person working on your premises is killed or suffers a major injury (including as a result of physical violence).
• Someone not at work is killed or suffers an injury as a result of an accident and is taken to hospital from the site of the accident.
• Someone not at work is injured in an accident at a hospital, and suffers a major injury. The different reporting requirements for accidents at hospitals are designed to ensure that accidents which would have required removal to hospital if they had happened elsewhere are reported.

Reportable major injuries include:

• Fractures, except to fingers, thumbs or toes.
• Amputation.
• Dislocation of the shoulder, hip, knee or spine.
• Loss of sight (temporary or permanent).
• Chemical or hot metal burn to the eye, or any penetrating injury to the eye.
• Injury resulting from an electric shock or electrical burn, leading to unconsciousness or requiring resuscitation or admittance to hospital for more than 24 hours.
• Acute illness requiring medical treatment, or loss of consciousness resulting from the absorption of any substance by inhalation, ingestion or through the skin or exposure to a biological agent.
• Any other injury which:

• leads to: hypothermia, heat-induced illness or unconsciousness;
• requires resuscitation or admittance to hospital for more than 24 hours; or if the injured person is already in hospital, then the injury would have resulted in admission for more than 24 hours.

A full list of reportable major injuries is on the pad of report forms and in the guide to the Regulations (see back page for details).

Over-three-day injuries

You must report accidents connected with work (including acts of physical violence) which result in an employee, or a self-employed person working on your premises being away from work or unable to do their normal duties for more than three days (including non-work days).

Examples: Over-3-day injuries

• A porter suffers a back injury when lifting a heavy load and is unable to work for four days.
• A receptionist is punched by an angry patient in Accident and Emergency, suffers severe bruising and is off work for a week as a result of the injury and shock.
• A doctor's finger is broken when it is trapped by a closing door, she is unable to do her normal work from Friday until Tuesday.

Diseases

You must report any case in which a doctor notifies you in writing that one of your employees is suffering from a disease specified in RIDDOR which is linked with the corresponding activity.

Self-employed people need to make their own arrangements to notify any reportable diseases they suffer.

Reportable diseases include:

• Some skin diseases, such as occupational dermatitis.
• Occupational asthma or respiratory sensitisation.
• Infections such as hepatitis, tuberculosis, legionellosis and tetanus.
• Any other infection reliably attributable to work with biological agents; exposure to blood or body fluids or any potentially infective material.
• Other conditions, such as occupational cancer and certain musculoskeletal disorders.

You can find out details about reportable diseases in the guide to the Regulations (see back page for details).

Infections

For the purposes of RIDDOR, an infection is the entry and multiplication of an infectious agent in the body causing a damaging reaction in the tissue. The infection and the damage caused may give clinical signs and symptoms of disease ('clinical' or 'symptomatic'), or may not be evident ('sub-clinical' or 'asymptomatic').

You need to report a case of infection only when you can reliably attribute it to the work that a person does. Infections which could have been acquired equally easily at work or in the community are not reportable.

Colonisation, in other words the presence and multiplication of infectious agents in or on the body, without a damaging reaction in the tissue, is not the same as infection and is not reportable as a disease.

Examples: Reportable diseases

Reportable

• A nurse contracts TB after nursing a patient with TB.
• A laboratory worker suffers from typhoid after working with specimens containing typhoid.
• A nurse suffers asthma and becomes sensitised to glutaraldehyde after working in a gastroenterology unit.
• A secretary suffers from work-related upper limb disorder.
• A surgeon suffers dermatitis associated with wearing latex gloves during surgery.
• A paramedic becomes Hepatitis B positive after contamination with blood from an infected patient.

Not reportable

• A nurse becomes colonised with MRSA after nursing patients infected with MRSA.
• A domestic catches chicken pox. Patients in areas where she has worked have chicken pox but so does her child.

Dangerous occurrences

Dangerous occurrences are specified events which may not result in a reportable injury, but have the potential to do significant harm.

Reportable dangerous occurrences include the following:

• The collapse, overturning or failure of load-bearing parts of lifts and lifting equipment.
• The accidental release of a biological agent likely to cause severe human illness (a hazard group 3 or 4 pathogen).
• The accidental release of any substance which may damage health.
• The explosion, collapse or bursting of any closed vessel or associated pipework.
• An electrical short circuit or overload causing fire or explosion.
• An explosion or fire causing suspension of normal work for over 24 hours.

A full list is included with the pad of report forms and in the guide to the Regulations (see back page for details).

Examples: Dangerous occurrences

Reportable

• A patient hoist falls, due to overload.
• Asbestos is released from ducting during maintenance work.
• A nurse suffers a needlestick injury from a needle and syringe known to contain Hepatitis B positive blood.
• A laboratory worker spills a container of formaldehyde.
• A container of a TB culture is broken and releases its contents.

Not reportable

• A domestic suffers a needlestick injury, the source of the sharp is unknown.
• A urine specimen container is broken and the contents are spilled.
• A doctor is injured by a sharp containing a patient's blood. The patient is not known to have any infection.

How to report

You must report fatal accidents, accidents resulting in major injuries, accidents to people who are not at work and dangerous occurrences to your local HSE office without delay (eg by telephone). Look in the phone book under HSE for the address and telephone number. If you have any difficulty obtaining details, ring HSE's InfoLine, on 0541 545500. You will be asked for brief details about the business, the injured person and the accident. You should follow up the initial report within ten days by sending in a completed accident report form (F2508).

You do not need to notify other accidents, but you must report them in writing on the relevant form (F2508) within ten days.

Diseases must be notificed in writing (on form F2508A) without delay.

Keeping records

You must keep a record of any reportable injury, disease or dangerous occurrence. This must include the date and method of reporting; the date, time and place of the event; personal details of those involved, and a brief description of the nature of the event or disease. The record must be kept for three years from the date you record the details. You can keep the record in any form you wish, for example by keeping copies of completed report forms in a file or recording the details on a computer.

Consultation

Employers should make records kept under RIDDOR available to safety representatives except where they reveal personal health information about individuals. The internal incident reporting systems which underpin RIDDOR reporting are likely to work better if you consult employee representatives when you draw them up.

The full text of the Regulations, together with guidance notes, are available in a separate detailed guide A guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 L73 from HSE Books. Forms F2508 and F2508A are available in a pad from HSE Books.

HSE priced and free publications are available by mail order from HSE Books, PO Box 1999, Sudbury, Suffolk CO10 6FS. Tel: 01787 881165 Fax: 01787 313995.

HSE priced publications are also available from good booksellers.

For other enquiries ring HSE's InfoLine Tel: 0541 545500, or write to HSE's Information Centre, Broad Lane, Sheffield S3 7HQ.

HSE home page on the World Wide Web: http://www.open.gov.uk/hse/hsehome.htm

This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory and you are free to take other action. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and safety inspectors seek to secure compliance with the law and may refer to this guidance as illustrating good practice.

This publication may be freely reproduced, except for advertising, endorsement or commercial purposes. The information is current at 4/98. Please acknowledge the source as HSE.

Printed and published by the Health and Safety Executive 4/98 HSIS1 C250