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Environmental Health & Safety2023-03-22T06:44:46-06:00

OFFICE OF ENVIRONMENTAL HEALTH & SAFETY

The mission of the Environmental Health and Safety Office at Northwestern State University (NSU) is to protect people, property, the environment, financial resources, and other resources in support of the University’s teaching, outreach, research, and student services.

The Environmental Health & Safety (EHS) Office is responsible for administering the campus safety, health, and environmental programs.

Risk Management is responsible for the administration of the University’s insurance program and coordination of insurance programs for NSU campuses

The Emergency Preparedness (EP) Office is responsible for administering the campus Emergency Preparedness Program and the Continuity of Operations Programs for Northwestern State University.

Asbestos is a building material that has been used in floor tile, ceiling tile, insulation, and numerous other materials for many years.  Asbestos fibers can cause serious health effects if they are not sealed into the material that they are a part of.

Northwestern State has a done a complete inspection of campus buildings for asbestos-containing materials.  The initial inspections of buildings were done in 1993-1994 by Inspectors from the State of Louisiana.

Asbestos Management Plans are maintained on all buildings with asbestos containing materials.  Those plans are located in the Environmental Health & Safety Office. The Management Plan includes a description of asbestos containing materials in the buildings, and procedures for re-inspecting buildings.

Asbestos Notification Letters

Who needs the Defensive Driving Course? Anyone (including Student Workers or Graduate Assistants) who will operate a golf cart, utility vehicle, or any other type of vehicle, including an automobile, on university business.

When an employee becomes an authorized driver, their name will be added to an “Authorized Driver” list published on this site monthly. When a driver is not authorized due to being a high risk driver, the employee and their supervisor will be notified via e-mail. The Motor Pool Office and the Travel Office will also be notified. Unauthorized Drivers are not allowed to drive on University Business.

No employee can drive a University vehicle, a rented/leased vehicle or their personal vehicle on University business without becoming an authorized driver. An employee must also be required to drive in the course and scope of their job duties in order to become an Authorized Driver.

Please turn in the Defensive Driving Certificate, and the [DA 2054] Driver Authorization Form at the same time.  If you have out-of-state driving records, please attach those to the other 2 documents and return all information at the same time. This will be a tremendous help when processing driver authorizations.

Important Notes to Remember with On-The-Job injuries:

  1. If an employee is seen by an urgent care/emergency room facility and required further treatment, it is important that the employee follow up with their worker’s compensation claim adjustor, so that all further appointments can be approved.
  2. If the employee did not return to work following the accident, he/she is required to submit a “Return to Work Status Report”, from the attending physician.  Any limitations or exclusions would be helpful if listed on that work status report.
  3. The first seven (7) days of missed work are considered the “waiting week” and are not eligible for indemnity benefits unless the employee has missed 14 or more days as a result of the injury.  Otherwise, indemnity benefits will start on the 8th day, including the weekend, at 66.666 percent of wages or salary.
  4. When the employee is approved to return to work, he/she is required to submit a “Return to Work Status Report” with physician’s clearance.  It must list any exclusions or limitations on the work status report.
  5. NSU does offer Transitional Return to Work, which may allow for light duty employment until the employee if fully released by their physician.

Relevant Documents

Employee Training

Only responsible for Blood Borne Pathogens and Driver’s Safety.

Keep all certificates in the departmental office, unless Student needs to be approved to drive on University business.  Check the requirements below.

Blood Borne Pathogens

Employee certificate is retained in employee unit supervisor’s office. High Risk Employees are required to take a face-to-face class.

Defensive Driver Training

Defensive Driver Training is only needed if driving is required in the course and scope of employment. Each student must complete a new form and new driving course annually, preferably in the first week of the semester each fall.

Student Employees: you must be on NSU’s Authorized Driver list before you are allowed to drive in the course and scope of your student employment (if first employment is in the Spring, and student employee must take prior to driving).  Driver Authorization Form and the Defensive Driving Certificate are required to be sent to the EHS Office.

Please forward the completed paperwork as listed below:

  1. [DA 2054] Driver Authorization Form (State of Louisiana)
  2. A printed Certificate of Completion for training course
  3. Non-Louisiana residents only: you will need to request an Official Driving Record from the state that issued your driver’s license and include a copy.

You will need to add your name to the “Certificate of Completion” and print certificate. EHS must have a certificate for the course to count towards your training and for you to become an Authorized Driver.

Potential Issues

In the past, there has been some difficulty in printing the certificates, so you may take the entire course and the certificate not print.  The State’s training course program seems to work better on Foxfire and Chrome and may encounter difficulty on Internet Explorer.  The certificate will come up on the screen but sometimes will not print. Take a screen shot with your computer and print the image.

Quarterly Safety Meetings

The following topics will be covered in Quarterly Safety Meetings:

Professional internship is defined as the internship or experiential training activities for students seeking professional degrees.  Student Experiential Learning Insurance provides coverage for students participating in approved Professional Internship Programs or Experiential Programs (e.g., accidental property damage, and accidental injuries to others while in the program setting).  Medical Malpractice Coverage will cover students will providing medically related services (e.g., wrong medication or dosage is accidentally given to patient).  Needle sticks are not covered under either policy, and the student’s personal health insurance would have to cover any expenses related those type accidents.

Related Documents

Property claims arise when damage occurs to content property or structural property that is owned by Northwestern State University (NSU).  In the event of a natural disaster or major loss, please contact EHS Office immediately to report damage.  The deductible for Property claims is $1,000 per incident.  Contents depreciated value will be factored into the total amount of the claim.  The University assumes no liability for loss or theft of personal property of students, employees and visitors to the campus.

What Information Is Needed to File a Claim

When a property loss occurs, the department is required to provide an itemized list of property that was damaged, destroyed, or stolen.  Estimates for repairs must be submitted prior to authorizing repairs of damaged items.  If a police report was filed, please provide the case number so a report can be obtained.  If a police report was not filed, please provide a detailed statement as to what happened.  Include any witness statements.  If possible, please take photographs of damaged items and submit with your claim information.  The department must provide the following:

Items under $1,000

  • Type of goods or equipment damaged, stolen, etc.
  • Number of each type of item damaged, stolen, etc.
  • Date purchased or approximate age
  • Approximate acquisition cost
  • Cause of damage
  • Location of damage, building and room number
  • Photographs of damage, if available
  • Police report case number, if applicable

Items over $1,000

  • All Items in the list above
  • State property tag number
  • Equipment inventory sheet
  • Model number
  • Serial number

All damaged property must be protected against further damage and must be made available for inspection.  Please do not discard property without contacting Risk Management for authorization.

Settlement is based on repair/replacement cost, less $1,000 deductible and depreciation.

State law requires that the claimant provide documented evidence that the damaged/stolen property has been repaired or replaced. Therefore, the settlement amount will be set aside until proof of repair or replacement is received.  In order to complete the claims process, please submit a copy of the repair invoice, purchase order, etc. with a copy of the cancelled checks showing proof of payment.  Also please submit account number you would like to be credited for this loss.

Purple Alert is Northwestern State University’s rapid notification system. At its core, Purple Alert is a multi-part communications process for disseminating alerts to NSU students, faculty and staff. Purple Alert are distributed through a company called Firstcall. Registration for Purple Alert will take place directly through a Firstcall supported website.  For more information on Purple Alert or to activate an account click here.

The Risk Management Unit of Northwestern State University handles claims covering the legal liability for the University arising out of occurrences resulting in injuries or property damage to NSU students, employees, and visitors to the University. Risk Management is responsible for the administration of the University’s insurance program and coordination of insurance claims. Any incident, on or off campus, that results in bodily injury or damage to property that may potentially be construed as the responsibility of the University.

Employee Accident Information is distributed with every safety meeting.  All information and forms are distributed with safety meeting information or available to print from this website (see: Safety Tips).

No documents have been uploaded to this Category yet.

Vehicle accidents must be reported immediately and investigated in a timely manner using ORM [DA 2041] Accident Report (Louisiana State Driver Safety Program). Printed copies of this form can be obtained from the NSU Environmental Health & Safety Office. Forms should also be located inside each NSU vehicle.

Automobile claims arise when Northwestern State University (NSU) is legally liable for bodily injury or property damage caused by the use of university owned, personal vehicles on university business, rented or leased automobiles.

All claims for liability or physical damage to state-owned, leased or rental vehicles are to be reported to the NSU EHS Office immediately at obannonj@nsula.edu or csmith062@nsula.edu.

A [DA 2041] Accident Report (Louisiana State Driver Safety Program) and [DA 2000] State Employee Incident/Accident Form must be submitted within 24 hours of an auto accident even if there is no damage to the vehicle or employee.

DEDUCTIBLE:  The deductible for auto collision and comprehensive claims is $1,000. All departments are responsible for the $1,000 deductible per accident, for collision and comprehensive coverage.

DRUG SCREEN: Post-Accident/Incident:  Any employee directly involved in an on-duty accident or incident, and whose action or inaction may have been a causative factor of same, shall be required to immediately submit to drug and alcohol testing if:

    1. Reasonable Suspicion:  Circumstances give rise to a reasonable suspicion of the employee’s drug or alcohol use or impairment, or
    2. Fatality:  The accident or incident resulted in a fatality; or seriously bodily injury, or
    3. Hazardous Materials Release:  The accident or incident resulted in or caused the release of hazardous waste as defined in LA R.S. 30:2173(2) or hazardous materials as defined in LA R.S. 32:1502(5).

Related Documents

Procedures for Enrolling Operators

Upon recognizing the need for an employee to operate a state-owned/leased/hired vessel by their supervisor, the employee shall complete the Authorization History Form (DA 2066). The information on this form shall be used to acquire the Water Operator Record (from the Department of Wildlife and Fisheries). The Authorization History Form and the WOR is then submitted to the Agency head or designee who shall review the operator record and sign the Authorization History Form. When employees are authorized to operate water vessels, they shall be enrolled in the “BoatUS” course (or other NASBLA-approved course) or the refresher course. A copy of the certificate of completion shall be retained on file.

It is the responsibility of the individual Agency to retain any/all records pertaining to the Water Vessel program (with the exception of records for the BoatUS Course) as the Department of Wildlife and Fisheries will NOT maintain such.

CONTACT US

Environmental Health & Safety Office
Emergency Preparedness
998 South Jefferson Street
Facility Services Building, Room 122
Natchitoches, Louisiana 71497

Phone: (318) 357-4424
Fax: (318) 357-4348

Chelsea Eddington, Assistant to the EHS Officer

VITAL INFO

There are 4 steps to Accident Reporting:

  1. Notify your supervisor
  2. Notify University Police 318-357-5431
  3. Notify EHS 318-357-4424 or csmith062@nsula.edu.
  4. Fill out the proper form

FAQ (General)

An accident just occurred. What is my next step?2022-09-14T12:27:04-06:00

Employee accidents must be reported immediately and follow these steps:

  1. Contact NSU Campus Police at 318-357-5431
  2. Contact the EHS csmith062@nsula.edu
  3. Contact your immediate supervisor
  4. Complete either the [DA 3000] Visitor/Client Post Incident/Accident Analysis, the [DA 2000] State Employee Incident/Accident Form, or the [DA 2041] Accident Report (Louisiana State Driver Safety Program) for automobile accidents. Report all facts pertaining to the accident. Submit forms to the EHS Office at 998 South Jefferson (on campus).

[DA 2000] State Employee Incident/Accident Form must also be completed for all employee accidents. This is a form specifically used by the Office of Risk Management for reporting purposes. It does not contain the detailed information needed to submit a Worker’s Compensation claim, thus the need for the other form.

Please either print or type this form. This is a box by box instruction sheet for completion of the form.

Agency: Northwestern State University

Accident Date: This is the actual date that the accident occurred.

Reporting Date: This is the date you are completing the form. It should be the same as the Accident Date, but if you complete this form on a different date, please indicate the current date.

Employee Name: Last name, First Name—please use your legal name, no nicknames.

Job Title: Please indicate your job title at the time of injury.

Date of Hire: If not known please leave blank, it can be filled in for you.

Department: Indicate the department that employs you.

Immediate Supervisor: Please indicate first and last name.

Describe in detail how the incident/accident occurred: Please use this area to describe exactly what happened as the accident occurred. What work activity was being performed? What tools or materials were involved, if any? Were there any water or liquids on the floor or area of the accident? Document all aspects of the accident so that your claim information can be expedited to the Office of Risk Management (ORM).

Parish where Occurred: In what parish did the accident occur?

Parish where Domicile: In what parish does the employee live?

Was medical treatment required? Indicate yes or no. This is any medical treatment at all.

Exact location where incident/accident occurred: Please indicate the exact physical location of the accident/incident. This would be a building, and room number, or a street address. If you are completing this report as the result of a vehicle crash, please indicate the exact location of the crash and the crash report number here.

Names of Witnesses: If there were any witnesses to your accident, please indicate their first and last names.

Name of Person completing this Section of Report: This should be the employee. If not, please indicate the first and last name of the person who completed the report.

Signature of person completing form: Report must be signed.

Date: Indicate the current date.

SUPPLEMENTAL INFORMATION TO THE DA-2000

Accident Date: This is the actual date that the accident occurred.

Accident Time: Time that the accident occurred.

Reporting Date: This is the date you are completing the form. It should be the same as the Accident Date, but if you complete this form on a different date, please indicate the current date.

Employee Name: Last name, First Name—please use your legal name, no nicknames.

Social Security No.: Must have your social security number not your employee identification number. The Worker’s Compensation system works via your Social Security number and you are not identifiable to the state agencies by your NSU identification number.

Address: Address where you would like to receive mail regarding your claim. Include city and zip code.

Date of Birth: indicate as follows: month/day/year

Campus Wide ID Number: Campus ID number needs to be listed also.

Phone Number: This can be your home phone or cell phone. This number needs to be where a claim adjuster can contact you.

Work Phone Number: Office phone number

Job Title: Please indicate your job title at the time of injury.

Date of Hire: Please fill in if known.

Department: Indicate the department that employs you.

Immediate Supervisor: Please indicate first and last name.

Did you file a Police Report? The answer to this should always be yes. University Police is a 24-hour agency and you should contact them immediately upon an accident occurring.

If you did not report to University Police…please call and report your accident to them. Details of accidents need to be captured at the time of the accident. Photos will also need to be taken.

Date of Report: Date police report was filed.

Report Number: If you know this number, please include it here.

Were photos taken? The answer to this should always be yes. Photos should always be taken to document the scene of an accident. This is specifically referring to photos taken by University Police.

Date: Should be on accident date, but could be another date after the accident.

By: University Police, Injured Employee, Witness-just need to indicate who took the photos.

Describe in detail how the incident/accident occurred: Please use this area to describe exactly what happened as the accident occurred. What work activity was being performed? What tools or materials were involved, if any? Were there any water or liquids on the floor or area of the accident? Document all aspects of the accident so that your claim information can be expedited to the Office of Risk Management (ORM).

Body Part Injured: Be specific about the part of the body injured, be sure to indicate left or right.

Nature of Injury: Be specific about the injury that you have.

Was medical treatment required? Indicate yes or no. This is any medical treatment at all. If yes, please check the type of treatment received.

Medical Treatment Required?? Emergency Room or Doctor: Please indicate yes or no. Then check the box beside the type of facility you visited.

On Campus: If you visited on campus health services, please check that box.

Emergency Room or Doctor: If you visited the emergency room or a doctor’s office for treatment of your injuries, please list the facility or doctor’s name, address and phone number. ORM needs to be able to contact the doctor or facility that rendered treatment.

Exact location where incident/accident occurred: Please indicate the exact physical location of the accident/incident. This would be a building, and room number, or a street address. If you are completing this report as the result of a vehicle crash, please indicate the exact location of the crash and the crash report number here.

Names of Witnesses and Phone Numbers: If there were any witnesses to your accident, please indicate their first and last names, and their phone numbers. They will also need to complete a witness statement for the report.

Name of Person completing this Report: This should be the employee. If not, please indicate the first and last name of the person who completed the report.

Employee’s Signature: Injured employee must sign the report. Report is incomplete without the employee’s signature.

Date: Indicate the current date.

After completing the form:

  1. E-mail it to Chelsea Eddington via email at csmith062@nsula.edu or drop it off at Room 122 of the Facility Services Bldg.
  2. Submit original form via campus mail to EHS Office.
How do I become an Authorized Driver?2019-03-27T14:32:03-06:00

Online Driver’s Safety (Defensive Driver) Training DA-2054: Driver’s Authorization Form and the Instructions to complete form Out-of-State License Information/Official Driving Records

To become an authorized driver you will need:

  1. To Take the Defensive Driving Course. Documents are attached that has the website and instructions for taking the course. Employee will need to print certificate and include with other paperwork. (Online Training Driver Safety-LEO and Non-LEO)
    1. A “P” number (personnel number) is required to take the course on LEO. Human Resources can provide you with that number.
    2. An employee that cannot utilize the LEO system, must still take the course, by the method listed on the alternate sheet.
  2. To Complete the DA-2054-Driver’s Authorization Form, instructions are included. Only the employee will sign this form.
  3. An Official Driving Record:
    1. Louisiana Driver’s License: Driver’s Safety Coordinator will obtain the driving record.
    2. Out-of-State License: The employee will have to obtain their driving records from the state that issued their license. There is a list attached of the more common states have been contacted to obtain records from for driving purposes. The employee will have to pay for the official driving records, if there is a cost involved with obtaining the records.

When all these items are received, and the driving record is clear then the employee will be authorized. An employee will only be notified if there is a problem with their driving record or authorization. You may contact the EHS Office for confirmation of your authorization. All required forms are attached to this document. Original forms are required in the EHS Office.

Please send via campus mail.

How do I complete a [DA2041] Driving Accident Report?2019-03-28T12:08:26-06:00

The [DA 2041] Accident Report (Louisiana State Driver Safety Program) form must be completed within 24 hours of the automobile accident in a State owned and/or rented/leased vehicle being used on state business and submitted to the EHS Office via email at csmith062@nsula.edu or Room 122 of the Facility Services Building.

Please do not fax the form, as it must be legible to ORM/FARA.

This report will then be sent to ORM/FARA within 48 hours of the accident. Even if all blanks cannot be filled in, please complete what you can and submit the report. Upon receipt of the form, the EHS Office will e-mail the completed form to ORM-DA2041@la.gov .

Please either print or type this form. This is a box-by-box instruction sheet for completing the form.

GENERAL INFORMATION

1. Agency Name: Northwestern State University

2. Contact Person for the Agency: Chelsea Eddington, EHS Officer

3. Phone number of the contact person: (318) 357-4424

4. ORM Location Code for Agency: 5160

5. State Vehicle Driver’s Name: This is the person driving the vehicle at the time of the accident; this must be the driver’s legal name.

6. Personnel Number: Enter the Driver’s Campus ID Number

7. Date of Accident: enter the date the accident occurred

8. Time of accident: Enter time of accident, please indicate AM or PM.

9. Exact Location of Accident: Enter the exact street names, intersection, milepost numbers, basically anything that will give the exact location. If you do not know, please ask the police officer that responds to the accident scene.

10. Describe how accident happened: Please provide as many details as possible as to how the accident happened. Include other vehicles, traffic lights, traffic signs or anything that may have played a role in the cause of the accident.

11.Seatbelt in Use: Indicate yes or no

STATE VEHICLE INFORMATION

12. State vehicle Driver’s Address: please give complete address to include city, state and zip code.

13. State Vehicle Drivers Home Phone: This can be home or cell number, include area code.

14. State vehicle driver’s Work Phone: Work phone number, include area code.

15. State vehicle driver’s license number: Include state and driver’s license number.

16. Age of State Driver

17. Sex of State Driver: Please indicate male or female.

18. Vehicle Owner’s name and address:

If NSU owned vehicle:

Northwestern State University
735 University Parkway/P.O. Box 5303
Natchitoches, LA 71457

If rented/leased vehicle, please check in vehicle for ownership paperwork.

19. Year of vehicle: can be located on registration

20. Make of vehicle: can be located on the registration

21. Model of vehicle: can be located on the registration

22. Body type: (4 door, 2 door, pickup, van)

23. Vehicle license number/Equipment Number/VIN:

License plate number: from the license plate on the vehicle

Equipment Number: This is the NSU car number.

VIN: This is a 17 digit/letter combination that is located on the registration.

24A. Where can the vehicle be seen? If drivable—indicate Northwestern State University. If the vehicle was towed, please indicate what wrecker service towed the vehicle, with a phone number.

24B. Describe damages: Indicate all areas of the vehicle that are damaged.

OTHER VEHICLE INFORMATION

This section must be completed for every “other” vehicle involved in the accident.

25. Other vehicle Driver’s name: You need to obtain the drivers name.

26. No longer required.

27. Other vehicle Driver’s license number: This would be helpful, state and driver’s license number.

28. Other vehicle driver’s age

29. Other vehicle driver’s sex: Indicate male or female

30. Other driver’s street address: Get a complete address including city, state and zip code.

31. Other vehicle Drivers Home Phone Number: This can be home or cell number.

32. Other vehicle drivers work phone: Work phone number or other phone number.

33. Vehicle owners name and address: If different from the driver. Be sure to get the city, state and zip code.

34. Year of vehicle: can be located on the registration

35. Make of vehicle: can be located on the registration

36. Model of vehicle: can be located on the registration

37. Body Type of Vehicle: (4 door, 2 door, pickup, van)

38. License number/Equipment number/VIN of other vehicle: can be obtained from registration.

39. Where can the vehicle be seen? Enter drivers address or Towing Company name and phone number.

40. Other Vehicle Insurance Company: full name of the insurance card for the other vehicle

41. Policy Number: other vehicle’s insurance policy number

42. Describe damage to vehicle: Indicate all areas of the vehicle that are damaged.

43. Estimate amount: not required for the 48 hour submittal.

INJURED

44. Name and address of Injured Person: name and complete address of any injured persons.

45. Phone number: any phone number where injured person can be reached.

46. PED: Check this box if the injured person was a pedestrian involved in the accident.

47. INS VEH: If the driver and/or passenger were injured in the State Insured vehicle, then place a check in the box.

48. OTHER VEH: If the driver and/or passenger were injured in the other vehicle, then place a check in the box.

49. Police Investigation: Indicate Yes or No—this should be yes, because all accidents involving state vehicles or leased vehicles for state business should be reported to the local police.

Type Report: Indicate what type agency worked the accident.

Report Number: Indicate report number here if it is known.

WITNESSES OR PASSENGERS

50. Name and Address: Indicate the name and full address of any passengers and/or witnesses.

51. Witness or Passenger: Please check the appropriate box to verify if the witness is an independent individual and not a passenger in either vehicle. If the witness is a passenger

in the State or other vehicle, then check the box in item 53 to indicate which vehicle the passenger occupied.

52. Phone number for the witness/passenger.

53. PED: Check this box if the witness was a pedestrian.

INS VEH: If the passenger was in the State Insured vehicle, then place a check in the box.

OTHER VEH: If the passenger was in the other vehicle, then place a check in the box.

54. Signature of the State Driver: The driver of the state vehicle involved in the accident must sign.

55. Name of the state driver’s immediate supervisor and a phone number with area code.

How do I complete a [DA3000] Student/Visitor Incident/Accident Investigation Form?2019-03-28T11:57:34-06:00

All incidents and accidents need to be reported to the EHS Office via the [DA 3000] Visitor/Client Post Incident/Accident Analysis. This is an internal NSU form that is used to submit the accident information to Risk Management Office. There are 2 pages to this report, and both must be completed.

This form must be completed immediately after the incident/accident occurs. If medical treatment is necessary, then contact University Police (318-357-5431) and report the incident/accident on your way to receive medical assistance. This report can be e-mailed toChelsea Eddington via email at csmith062@nsula.edu or dropped off at Room 122 of the Facility Services Building.

Please DO NOT fax the form, as when faxed it is usually not legible.

Please either print or type the form. This is a box by box instruction sheet for completion of the form.

Date and Time of Accident: This is the actual date and time that the accident occurred.

Visitor/Client (Student) Name: Please use your legal name, no nicknames.

Visitor/Client (Student) Address (Home and Local): Address where you would like to receive mail regarding your claim. You should list your home and local addresses if you are a student.

Claimant’s (Student/Visitor) Telephone #: This can be your home phone or cell phone. This number needs to be where a claim adjuster can contact you.

Claimant’s (Student/Visitor) Detail how the incident/accident occurred: Please use this area to describe exactly what happened as the accident occurred. What work activity was being performed? What tools or materials were involved, if any? Were there any water or liquids on the floor or area of the accident? Document all aspects of the accident so that your claim information can be expedited to the Office of Risk Management (ORM).

Did the employee ask the claimant (Student/Visitor) if he/she was injured? Check one box.

Did the Claimant (Student/Visitor) verbally express an injury to any part of his/her body? Check one box.

If the Claimant (Student/Visitor) expressed an injury, what part of his/her body did they state was injured? Please be specific (right/left and body part).

If the Claimant (Student/Visitor) expressed an injury, was medical care offered? Check one box.

Did the Claimant (Student/Visitor) accept or decline medical care? Check one box.

Were there Witnesses: Yes or No

Witness’s Name, Address, and Telephone Number: If there were any witnesses to your accident, please indicate their first and last names, address as well as telephone numbers.

Witness Statements Attached: If you answered yes to the previous question, please make sure any witnesses complete a witness statement.

Student/Visitor Accident Supplemental Form for DA-3000

Date and Time of Accident: This is the actual date and time that the accident occurred.

Student/Visitor Name: Last name, First Name—please use your legal name, no nicknames.

NSU ID No.: Must have your NSU ID number, if you are a NSU Student.

Date and Time of Accident: This is the actual date and time that the accident occurred.

Detail Description of Accident Location: Give as many details as possible about location of accident. Photos are the best to document an accident scene.

Is this a state owned or leased facility? Indicate which one.

State Building Number: Complete if known,

Student/Visitor Detail how the incident/accident occurred: Please use this area to describe exactly what happened as the accident occurred. What work activity was being performed? What tools or materials were involved, if any? Were there any water or liquids on the floor or area of the accident? Document all aspects of the accident so that your claim information can be expedited to the Office of Risk Management (ORM).

Were there Witnesses: Yes or No

Witness Statements Attached: If you answered yes to the previous question, please make sure any witnesses complete a witness statement.

Witness’s Name, Address, and Telephone Number: If there were any witnesses to your accident, please indicate their first and last names, address as well as telephone numbers

Detail Description of the Accident Location: Please indicate the exact physical location of the accident/incident. This would be a building, and room number, or a street address. If you are completing this report as the result of a vehicle crash, please indicate the exact location of the crash and the crash report number here.

Check the appropriate environmental condition that is applicable to the accident: Check any and all boxes that apply to the conditions on the date and at the time of the accident.

Check the appropriate box that pertains to the accident: Check any box that applies to the accident. Complete any explanation blanks that apply to the accident. Give as much information as possible.

Retaining Items: Please read question so you are aware of what to do in regard to retaining items involved in the accident.

Was the Claimant (Student/Visitor) authorized to be in this area? Yes or No

Did any employee observe anything before/after that is relevant to the accident? Yes or No.

If yes, was a statement obtained and attached? Yes or No

Was there a report of any observed conditions at the accident scene? Yes or No

Was a University Police Report filed? Yes or No

Report Number: complete if available.

Were pictures taken and are they attached to the report? Yes or No. Please send all photos via e-mail to the EHS Office.

Name and Position of the Employee completing this Report: This should be the employee. If not, please indicate the first and last name of the person who completed the report.

Date: Indicate the current date.

Signature of Employee: Please sign indicating that you completed the report for submission.

After completing the form:

  1. E-mail it to Chelsea Eddington via email at csmith062@nsula.edu or drop it off at Room 122 of the Facility Services Bldg.
  2. Submit original form via campus mail to EHS Office.

The EHS Office will use this form to report the accident/incident to the Office of Risk Management.

Please make sure all parties involved understand that the University assumes no liability for the accident/incident.

The University completes the paperwork, but all decisions related to the claim are made by the Office of Risk Management.

How do I determine if my Driver’s Safety Course is valid or expired?2019-03-28T12:31:06-06:00

  1. Access LEO by clicking this link: https://leo.doa.louisiana.gov/irj/portal.
    • If you have not accessed LEO before, click the “First Time User?” link and follow the directions.
    • If you do not remember your password, click the “Unlock/Change Password” link.
    • If you have any other problems click the “Online Help” link.
  2. Login to the site with your employee credentials.
  3. Go to My Training. (Tab at top of page.)
  4. On left side, go to Training Transcript.
  5. Click the Training Transcript.
  6. All courses are listed and expiration date is listed to the right.
  7. Check the expiration date of the Driver’s safety course. If expired, retake course. If it is expired, and you do not retake you will not be authorized to drive.
  8. Print the training transcript.
How do I register for Purple Alerts?2019-03-28T12:38:34-06:00

Purple Alerts are distributed through a company called Everbridge.  Registration for Purple Alerts will take place directly through a Everbridge supported website. You must be a Northwestern State University student, faculty or staff member in order to register for Purple Alerts.

You can access the member portal at the following link:

https://member.everbridge.net/index/453003085612883#/login

You can use your NSU credentials to login to the website and change your information. Instructions are in the Frequently Asked Questions Section.

Any questions, please e‐mail Purple Alert. purple‐alert@nsula.edu

Frequently Asked Questions

What is an Emergency?

An emergency is a situation which poses an immediate risk to the health and safety of the campus community.

Why should I provide my emergency contact information?

Having information enables you to make choices regarding your personal safety. Providing your cell phone and other contact information ensures that those with the latest information can contact you quickly and easily.

Why should I sign up?

About 90 percent of today’s college students have cellular phones and carry them wherever they go, as do many faculty and staff. We hope we’ll never have to use this system, but in the event of an emergency, this may be the fastest was to get information to you.

Am I required to sign up?

No. It is your option to sign‐up your personal information. All Northwestern State University e‐mail addresses are automatically entered into the system, and those e‐mail address will always receive e‐mail alerts, even if no other personal information is ever entered.

Who receives the emergency alert messages?

Northwestern State University students, faculty, and staff that are registered in the Purple Alert system will be sent the alert. University e‐mails will always be sent the alert. Personal contact information will only receive the alerts if they are registered.

Will my emergency contact information be published?

No, it is only to be used by NSU for notification of an emergency.

Who decides when a Purple Alert message is to be sent?

Key Administrative personnel determine the circumstances in which the system is used and then initiate the process. The system is used for emergency situations in which there is an immediate risk to the health & safety of the campus community or when campus closures are necessary.

What happens when the Purple Alert is activated?

When activated, Purple Alert sends a brief notice about the situation and instructions of what to do. The message is sent via various mechanisms, including cell phone text message, cell phone voice call, landline phone call, and e‐mail messages.

Purple Alert will also send updates as available and dependent upon the circumstances of the alert. Some alerts may not require any further updates, and some alerts may continually update you of the situation, depending on the emergency occurring.

Should I respond to the messages that I receive from Purple Alert?

Yes, both the e‐mail and the text messages ask for a response, either click the link or respond with Yes. Please take time to respond, so that the notification service will stop trying to notify you and will move onto the next person on the list.

Valuable time is spent trying to make sure everyone is contacted, so by not responding, the system continues to attempt to notify you of the emergency situation.

So what happens then?

Additional information will be made available to you via University’s website, e‐mail, phone, and campus radio and television resources, among other means.

Additional Purple Alerts may be sent depending on the emergency situation. You will be updated as the situation dictates.

How do I know I’m receiving a Purple Alert message?

“Purple Alert” will be in the subject of the e‐mail, listed first in the text message, and vocalized in the voice phone call.

Am I going to get inundated by messages from NSU?

No. Strict protocols are in place for use of the Purple Alert system. It will be activated ONLY in the instance of an emergency in which poses an immediate risk to the health and safety of the campus community or for campus closures. It will also be tested occasionally.

Where is the registration page?

The registration page is located at https://member.everbridge.net/index/453003085612883#/login.

You will click the green button that says “Use my network Credentials to login”. You will be directed to the “My Profile” page where you can edit your information.

On the “My Profile” page, click Edit, and then add the ways and contact information for notification during an emergency. You must enter 2 contact methods. The information will not save unless 2 methods of contact are entered.

Please leave your registration e‐mail as your NSU e‐mail address.

Be sure to click Save.

Changing your information after you register:

In order to change your information after you register, you will go to the member portal at https://member.everbridge.net/index/453003085612883#/login. You will click the green button that says “Use my network Credentials to login”. You will be directed to the “My Profile” page where you can edit your information.

On the “My Profile” page, click Edit, and then add or change any information that you would like to.

Be sure to click Save.

How do I delete my information from the Purple Alert System?

You cannot completely delete yourself from the system, as all NSU E‐mail addresses are automatically in the Purple Alert system and will always receive alerts. You may choose not to register your personal phone numbers or e‐mail addresses.

Any questions or need a registration e‐mail, contact Purple‐Alert@nsula.edu.

How do I request a Certificate of Insurance?2019-03-28T10:56:12-06:00

Use the Certification of Insurance Request Form to obtain a University Certificate of Insurance when an individual or an organization with whom the University has entered into an agreement with requires proof of insurance. Northwestern State University certificates of insurance can only be issued in connection with a Written Agreement, Purchase Order, License, Permit, RFP, or other document that requires a certificate of insurance.

A certificate of insurance should not be issued to a third party who may be working on University property. If a third party vendor requires a certificate of insurance for work being done on University owned/leased property, please contact the Environmental Health & Safety Office.

Certificates of Insurance should be requested by University employees only, and should be requested at least 10 business days prior to when a certificate is required by the certificate holder and/or the start date of the agreement/contract. The University cannot guarantee that a certificate will be issued in a timely manner if the request is sooner than 10 business days. You will receive a complete certificate by way of e‐mail. The identified certificate holder will receive a certificate by e‐mail if one is identified, and if an e‐mail address is submitted. Certificates are typically produced within 3‐5 business days. Certificates are not mailed to a certificate holder.

Certificate Holder/Agreement Information

The Certificate Holder will be the individual or organization with whom your department has written Agreement, Purchase Order, Contract, License, Permit RFP or other written document that requires a University Certificate of Insurance. In order to produce a certificate that meets the requirements of the party with whom the University has an agreement, carefully review the agreement and provide complete information about the Certificate Holder (name, address, contact person and e‐mail) and the insurance requirements (insurance type, agreement start and end date, whether the certificate holder or other entity must be name additional insured and any other special conditions) that must be met.

Additional Insured Status requested by way of Written Contract or Agreement:

Please note that additional insured status can only be granted by way of written contract or agreement.

Your agreement with the outside entity will state whether or not additional insured status is required by that entity.

Additional insured status is usually found within the insurance section of the agreement with the party requesting the certificate of insurance. You will need to review your agreement before requesting additional insured status.

If you have any additional questions, contact Chelsea Eddington at scsmith062@nsula.edu or (318) 357‐4424.

Instructions for the Certificate of Insurance Request Form

Date: Enter current date

NSU Contact Information: This is the NSU requestor.

Name: This is the person requesting the certificate of insurance that works at NSU

Office Phone: This is the requestor’s NSU phone number.

E‐mail Address: Requestor’s NSU e‐mail address.

Insurance Required: What kind of insurance certificate are you requesting?

Why do you need the insurance certificate?

General Liability

Automobile Liability

Other: You must enter an explanation in the blanks provided.

Certificate Holder Information:

  • Third Party or Company Name: This is the company or entity that needs the certificate of insurance from the University. They are the reason you are requesting this certificate.
  • Contact Name: Need a person to contact in case there is a question about the insurance certificate. This assists ORM, in case they need questions answered.
  • Mailing Address: Needed to complete the insurance certificate.
  • Contact Phone Number: Please provide contact’s phone number, in case of questions.
  • Contact E‐mail address: Please provide a contact e‐mail address, so that contact can be made if necessary.

Additional Insured: If this certificate of insurance is requested by a company or entity and there is a contract, MOU, or agreement of any type, then that contract must be attached to the certificate of insurance request. Certificates of Insurance will not be issued by ORM without the contract attached.

Agreement Dates: Please list beginning and ending dates of the contract.

Reason for Certificate: Please indicate why you need the certificate of insurance.

How do I verify my Louisiana Employees Online (LEO) Safety Courses?2019-03-28T12:14:57-06:00

  1.  Access LEO by clicking this link: https://leo.doa.louisiana.gov/irj/portal.
    • If you have not accessed LEO before, click the “First Time User?” link and follow the directions.
    • If you do not remember your password, click the “Unlock/Change Password” link.
    • If you have any other problems click the “Online Help” link.
  2. Login to the site with your employee credentials. Obtain these from Human Resources.
  3. Go to My Training. (Tab at top of page.)
  4. On left side, go to Training Transcript.
  5. Click the Training Transcript.
  6. All courses are listed and expiration date is listed to the right.
  7. Check the expiration dates:
    1. Driver’s safety course-must be taken every 3 years. If expired, retake course. If it is expired, and you do not retake you will not be authorized to drive.
    2. Blood Borne Pathogens-must be retaken every 5 years.
  8. Print the training transcript.
How do obtain a PIN number to login to Louisiana Employees Online (LEO)?2019-03-28T12:43:07-06:00

An ISIS number or “P” number is needed. It is a number that begins with a “P” and has 8 numbers.

You must be a full time employee. Employees that are not full time do not have an ISIS number.

You can obtain this number from the Human Resources Office, (318) 357-6152.

If you are a new employee, please contact Human Resources for assistance.

Once you have a “P” Number you can use it for all online training with the State of Louisiana (Defensive Driving, Blood Borne Pathogens, Ethics, Sexual Harassment, etc.).

Accessing Louisiana Employees Online (LEO)

Access LEO by clicking this link: https://leo.doa.louisiana.gov/irj/portal.

  • If you have not accessed LEO before, click the “First Time User?” link and follow the directions.
  • If you do not remember your password, click the “Unlock/Change Password” link.
  • If you have any other problems click the “Online Help” link.
What do I do in the event of an elevator malfunction?2021-11-10T13:43:43-06:00

If you are trapped in an elevator:

  1. Press the “Emergency” button or the “Bell” button.
  2. Use the elevator phone. It will connect to Security.  If for any reason the phone does not work, continue ringing the bell until someone outside the elevator has heard you.
  3. Remain calm.

If you observe a malfunction from outside an elevator:

  1. If you think someone may be trapped inside, Notify University Police at 5431 (318-357-5431) immediately.
  2. If there is a person trapped inside the elevator, assure them that assistance is on the way.
  3. If no one is trapped in the elevator, call the Physical Plant at 4519 (318-357-4519) to report the Elevator problem. Also call University Police to report the Elevator Malfunction.
  4. Secure the elevator. Place signs on the Elevator door indicating that the elevator is “Out of Order”.  This will prevent persons from entering the elevator.

During normal hours contact the Physical Plant at #4519 or (318) 357-4519

After normal hours contact the University Police at #5431 or (318) 357-5431

The number to the Power Plant is #5886 or (318) 357-5886

This is what will happen:

  1. University Police will call for assistance.
  2. Maintenance personnel will respond as soon as possible.

FAQ (Smoking)

When did the Tobacco Free Policy go into effect?2019-03-29T08:50:59-06:00

The policy went into effect on August 1, 2014.

How does the new policy differ from the previous policies?2019-03-29T08:51:31-06:00

The new policy makes all campuses of Northwestern State University Tobacco Free.  This includes all University Property, whether owned or leased.

What is considered a tobacco product and therefore prohibited by the policy?2019-03-29T08:52:11-06:00

  • Cigarettes
  • E-Cigarettes
  • Cigars
  • Snuff
  • Snus
  • Water Pipes
  • Pipes
  • Hookahs
  • Chew
  • Any other non-combustible tobacco product
Does the policy prohibit me from bringing tobacco products to work?2019-03-29T08:53:07-06:00

No.  You may bring tobacco products to work but you may not use the products on any campus of Northwestern State University.

Who does the policy apply to?2019-03-29T08:53:38-06:00

  • Students
  • Faculty
  • Staff
  • Visitors
  • Contractors
  • Vendors
What areas of campus does the policy apply to?2019-03-29T08:54:03-06:00

All property of Northwestern State University–all campuses.  Rented and leased properties are also covered by the policy.

Are any locations exempted?2019-03-29T08:54:30-06:00

No.

How do I know where Northwestern State’s property begins and ends?2019-03-29T08:55:12-06:00

  • Natchitoches Campus:  The Natchitoches Campus has boundaries of Chaplain’s Lake, University Parkway, and the Hwy 1 ByPass.  You must be across University Parkway to be off of University Property.
  • Shreveport Campus:  The Shreveport Campus is much more difficult to describe the boundaries.  The
  • Leesville Campus:  The Leesville Campus is a remote site with boundaries of forest and a state highway.
  • CenLA Campus:  Includes the building that the offices are located in
Am I allowed to smoke in my car while it’s parked on Northwestern State’s property?2019-03-29T08:55:51-06:00

If your vehicle is parked on NSU property then you are not allowed to smoke in your vehicle.

Am I allowed to leave Northwestern State University’s property for tobacco use during my workday?2021-04-27T13:42:17-06:00

If you leave University property, you should have approved annual or compensatory leave for the time taken.

Am I allowed to take breaks to leave Northwestern State University’s property to smoke?2019-03-29T08:57:13-06:00

If you leave University property you should have approved annual or compensatory for the time taken or be on your approved lunch break.

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