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Hazard Reporting

It is critically important that NPS Personnel report all hazards to the safety office. We want to investigate and mediate any hazard discovered to prevent mishaps! 

To make it as easy as possible for personnel to report, we have multiple different methods of reporting.

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Online "Report a Hazard" Form

We have created an Online Form to Report a Hazard that all NPS personnel can utilize.  The form allows users to report hazards annonymously if they chose to do so.


Unsafe/Unhealthful Reporting Form

Copies of Unsafe/Unhealthful Reporting Forms are available on all Departmental Safety Bulletin boards.   Completed forms may be dropped off at our offices, Faxed to 831-656-7710, or emailed to  


Come see us in person!

People are also always welcome to come by our offices to report in person!


We are on the corner of Stone Rd and Cottage Way.  Our building is just behind Cafe Del Monte!



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If you are dissatisfied with the assessment of the alleged hazard made by the Regional Complex OSH office or with actions taken to abate a confirmed hazard, you are encouraged to confer with the Regional Complex OSH office to discuss the matter further. If after the discussion, you are still dissatisfied, an appeal may be made to the cognizant Commanding Officer, Officer in Charge, or ACOS.

The appeal must be in writing and contain at least the following information:

  • A description of the alleged hazard including its location and standards violated if known (a copy of the original hazard report will suffice);
  • How, when, and to whom the original report of the alleged hazard was submitted; and
  • What actions (if known) were taken as a result of the original report.
  • A statement explaining why the actions taken as a result of the original report were unsatisfactory and are being appealed.

The CO, OIC, ACOS, or his/her representative, will respond within 10 working days. An interim response be forwarded if the Commander’s investigation is incomplete at this time.

If still dissatisfied or if you have not received a response within 20 working days, you may appeal to the next higher level of command. The sequence of appeals thereafter shall be to:

A. Commander Navy Region Southwest 937 North Harbor Drive San Diego, CA 92132-0058

B. Commander Naval Installations 2713 Mitscher road Ste 300 Anacostia Annex, Washington D.C. 20373-5802

C. Chief of Naval Operations Code N454 Crystal Plaza #5 Room 678 2211 Jefferson Davis Highway Arlington, VA 22244-5180

D. Assistant Secretary of the Navy Installation and Environment 1000 Navy Pentagon Room 4A686 Washington, D.C. 20350-1000

E. Under Secretary of Defense Environmental Security Pentagon Room 3E792 Washington, D.C. 20310

The final appeal authority for military personnel is the Under Secretary of Defense Environment Security.

In the event you are a dissatisfied civilian employee, you may contact, in writing, the Office of Federal Agency Safety Programs, U.S. Department of Labor, Washington, D.C. 20210. This final appeal must describe in detail, the entire previous processing of appeal and set forth objections thereto. *


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Mishap Reporting


Mishap investigation, reporting and record keeping are critical elements to the Navy’s safety and health efforts. Determining the cause and identifying problem areas can help us better understand how to correct hazardous working conditions. The process can assist us in preventing and/or eliminate future reoccurrences, as well as educating us on the lessons learned.


Online "Report a Mishap" Form

We have created an Online Form to Report a Mishap that all NPS personnel can utilize.  Shortly after submitting, a Safety Specialist will follow up with you.


Mishap Program Requirements

This page outlines basic MISHAP reporting program requirements, establishes our policy regarding the reporting and investigation of mishaps and serves as guidance for supervisors to follow to report a mishap. Please note that the content of this page does not serve as a substitute to the following governing Instructions or Regulations:

OPNAVINST 5100.23G, Chapter 14,

• OPNAVINST 5102.1D Navy & Marine Corps Mishap & Safety Investigation Reporting & Record Keeping Manual

OSHA Regulations, Standards 29 CFR 1904.7

OSHA Fact Sheet on new requirements for reporting severe injuries or hospitalizations.


Any civilian with a work-related illness or injury that involves medical treatment beyond first aid, including light duty and/or lost work time is considered a reportable mishap. In addition, off-duty military mishaps or injuries should also be reported. Reporting is filed on-line thru ESAMS or to your program officer if you are a student.


Scope and Applicability: The provisions of this page apply to all Federal civilian employees and Military service members of Naval Support Activity Monterey (NSAM) and its Tenant Commands. All reportable mishaps are required to be submitted into ESAMS. Requirements:

• All employees have the responsibility to notify their supervisor when a mishap or injury has occurred in the workplace. In addition, all off-duty military injuries shall also be reported.

• Supervisor shall submit a report of mishap or injury via ESAMS within 3 working days .

• All fatalities shall be reported within 8 hours. Amputations, hospitalizations and loss of an eye shall be reported within 24 hours. Initial telephone reporting for fatalities or sever injuries to the Safety Office.

• Medical assistance will be provided if applicable: Call 911 emergency services in case of serious or life-threatening injuries.

• Supervisor will assist with investigation of mishap in order to determine steps to be taken to prevent recurrences.


For Workers Compensation information and forms please contact the following offices:

• NPS civilian mishaps will require Workers’ Compensation Forms that may be accessed by contacting the local HRO Office; or by going to the HRO Workers' Injury Compensation site which has forms, details about responsibilities, and instructions for filing.

• NSA Monterey civilian mishaps will require Workers’ Compensation Forms that may be accessed by contacting CNRSW HRO at (619) 532-1309/1274/3525 or Fax (619) 532-1287


Injury/Illness Treatment (Civilian Employees Only)

Workers Compensation Forms, e.g., CA-1, CA-2, etc. should be delivered to the Human Resources Office NPS, Employee Services. Questions should be directed to (831) 656-1187. For details on The Federal Employees' Compensation Act (FECA), see the Department of Labor's Site for an Overview and Material Assistance. Note that medical documentation is required for all lost workdays and all ORIGINAL Workers Compensation Forms must be sent to HRO.

Medical Referral Form -  Employees shall report immediately to their supervisor any occupational injury or illness. If an employee requests medical care, the supervisor shall offer to refer the employee to the activity medical treatment facility (MTF) occupational health department, if available, for examination and recording of the injury in the employee medical record. Referral to the activity MTF is not mandatory on the employee’s part, nor shall it be construed as the initial choice of the attending physician. If the employee elects evaluation at the activity medical service, the supervisor shall furnish OPNAV 5100/9, Medical Referral Form.


What to Report:

Class A Mishap. The resulting total cost of reportable material property damage is $1,000,000 or more; or an injury or occupational illness results in a fatality or permanent total disability.


Class B Mishap. The resulting total cost of reportable material (property) damage is $200,000 or more, but less than $1,000,000; or an injury or occupational illness results in permanent partial disability; or three or more personnel are inpatient hospitalized.


Class C Mishap. The resulting total cost of reportable material (property) damage is $20,000 or more, but less than $200,000; a non-fatal injury that causes any loss of time from work beyond the day or shift on which it occurred; or a non-fatal illness or disease that causes loss of time from work or disability at any time (lost time case).


Class D Mishap. A work-related/on-duty reportable injury or occupational illness not otherwise classified as class a, b, or c mishap (e.g., injuries requiring medical treatment beyond first aid, loss of consciousness, light duty, limited duty, restricted work, or job transfer).


mishap process


Forms and Publications:

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Near-Miss Reporting

Where you almost injured because of a hazard?  Then we very much would like to hear about it!


Your "Near-Miss" could lead to someone else having a mishap if we don't investigate and mitigate the hazard!


Near Misses can be reported by emailing a completed Near Miss Reporting Form to  Near-Misses can also be reported through ESAMS.