301 & 417 Job Aid Flashcards
301 Reporting – If the reported incident involves more than one employee?
Click the ‘Add More’ to open up another employee selection field. This should only be used when all details of the incident are identical, including injuries and corrective actions. If incident details are different, separate 301’s entries are required.
301 Reporting – If the location of the incident/accident is not available as an option for selection, what should be done?
Select ‘Other’ and enter all details in the Exact Location field.
301 Reporting – What actions must a supervisor/manager take to prevent a recurrence?
You must initiate a Corrective Action in order to prevent a re-occurrence of the incident.
301 Reporting – Who is responsible for forwarding the email notification to their divisional distribution group?
Supervisor/Manager
301 Reporting - For incidents/accidents that require reporting to WSIB, what steps must be taken?
Medical Aid/Health Care Received or Lost Time must be selected as the Incident Category.
301/417 – Who is our Health and Safety Specialist?
Monica Ahluwalia – CMS
301 Review – How can you search for a specific incident?
- Entering the ‘Incident #’ in the search filter
- Entering the ‘Employee Name’
- Search all incidents based on either the
‘Incident Category’ or ‘Accident Type’ - By using the date range filter for ‘All
Incidents Dated From’ and ‘All Incidents
Dated To’
301/417 Review – How many revisions can be made by a supervisor/manager?
Three revisions. If any additional revisions are required, contact your Health & Safety Specialist for the Form 301/417 to be updated accordingly.
417 Reporting – Who is responsible for completing the Report?
- Formally reported by all Drivers/Operators
on a fillable PDF 417 Form - If unable to complete a Form 417 to report
the vehicle damages, the
Manager/Supervisor is able to complete the
report on their behalf
417 Reporting – When is this required to be completed by?
Regardless of the nature of the incident, the driver of the vehicle must complete a Form 417 before leaving work at the end of shift.
417 Reporting – When must a form 417 be completed?
A Form 417 is to be completed for all damage, collisions, and incidents (including vandalism & theft) involving City owned, leased, or rented vehicles, or equipment (including property damage - City and/or Third Party).
417 Reporting – What employee information needs to be entered?
- Driver’s License Expiry date (using the
calendar) - Condition/Endorsement (or click N/A)
- Class (e.g. G1, G2, or G)
- Employee Injured (Yes, or No) *If selecting
Yes, an additional text box will appear to
detail the employee’s injuries.
Note: A Form 301 needs to be completed
417 Reporting – What City Vehicle details are required when reporting for an accident?
- Fleet, Unit or Asset Number
- Plate Number (or select N/A if reporting
damage to an unplated vehicle or
equipment) - Make, Model and VIN number
- Indicate if there is damage to the City
vehicle (Yes or No). If Yes, an additional text
box will open to detail the damages - To the best of your ability, estimate and
select if the City vehicle damages exceeds
the threshold for the appropriate vehicle
type - Detail any previous damage to the City
vehicle
417 Reporting – What information is required to be obtained from the third party when reporting an accident involving a city vehicle?
- Name, Address, City, Phone #
- Drivers Licence & Expiry
- Driver injured
- Plate, Make, Model & Colour
- Damage to their vehicle
- Owner
417 Reporting – Employees must contact whom when in a collision with a city vehicle that involves a third party?
Employees need to contact the Police to report all vehicle collisions involving Third Party vehicles or pedestrians.
417 Reporting – What attachments to include in the Supplementary Documents section?
- Police or Collision Reporting Centre
documents (if obtained) - Pictures of accident scene and damage to
vehicles - Pictures of property damage
- Picture of Third Party driver’s license,
ownership & insurance - Drawing of accident scene (if vehicle
collision involved a Third-Party vehicle or
pedestrian)
417 Review – How can you search for a specific incident?
- Incident #’s for Form 417’s begin with the
letter V - Entering the ‘Employee Name’
- Search all incidents based on either the
‘Incident Type’ or ‘Motion’ of the City vehicle
at the time of the incident - Using the date range filter for ‘All Incidents
Dated From’ and ‘All Incidents Dated To’ - Search all incidents that a Corrective Action
has not been assigned with the search filter
‘Reported with Corr. Actions’ and selecting
‘No’
Sections of FORM 301?
- Employee Incident Information
- Incident Basics
- Witness Details
- Incident/Accident Details
- Recommended Corrective Action
- Supplementary Documents
- Save Draft, Load Draft, Submit
- Medical Aid and Lost Time Details and Return to Work (WSIB
information)
Form 301
Who gets an email notification?
- Form 301 will only allow for three revisions to be made. If any additional revisions are required, after the Supervisor/Manager has already made three revisions, contact your **Health & Safety Specialist **for the Form 301 to be updated accordingly.
Form 417 Tabs?
- Employee Details
- Accident Occurrence
- City Vehicle Details (Vehicle #1)
- third Party Driver/Vehicle Details (Vehicle #2)
- Witness Details
- Police Information
- City Vehicle Action
- Occurrence Details
- Accident Scene Drawing
- Supplementary Documents
- Save Draft, Load Draft, Submit
- Managers/Supervisors ONLY - Report on Behalf of Employee
- Managers/Supervisors ONLY - Corrective Actions –
Form 417 What must be done on form 417 to prevent further incidents?
- a Corrective Action needs to be added by the Manager/Supervisor for every reported 417 to avoid a recurrence of the incident.
