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 5102.1D Navy & Marine Corps Mishap & Safety Investigation Reporting & Record Keeping Manual
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).
Forms and Publications:
- Employee Discomfort Survey
- Unsafe / Unhealthful Working Conditions
- Near-Miss Reporting
- Medical Referal Form (OPNAV Report: OPNAV 5100-28)
- NSAM/NPS Safety Gram on Mishap Reporting
- CA-1 Form: Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
- CA-2 Form: Notice of Occupational Disease and Claim for Compensation
NPS Staff and faculty can access ESAMS to report an "unhealthy employee working condition". Reports can even be filed anonyomously through the system.
This is our prefered method of reporting but students do not typically have access to ESAMS and will need to utilize one of our other methods of reporting.
What is ESAMS?
The Naval Postgraduate School uses the web-based module, ESAMS (Enterprise Safety Applications Management System), to track inspections of NPS spaces, mishaps, and safety related trainings.
What does ESAMS mean to NPS staff, faculty, and students?
All NPS employees and certain students that work in labs which require additional safety training are required to be enrolled into the ESAMS database. There are required safety related trainings for all NPS personnel. Many of the trainings may be done online through ESAMS. Supervisors can use ESAMS to track training completion of employees as well as assign new training to employees.
A detailed description of ESAMS follows:
Mishap Analysis Reports
(Administrators can search by year, command type, command, installation and program. The following is a list of current mishaps fields that have been used for analysis)