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Policies, Reports & Forms


Executive Order 13

On June 4, 2013, Executive Order 13 established the Health and Safety Leadership Team composed of 11 of the state's top leaders and safety professionals. Read the full Executive Order.


Space Heater Use Program – covers safe guidelines for the use of space heaters when work areas cannot maintain a 68°F to 76°F degree temperature threshold.


North Carolina State Employees Workplace Requirements Program for Safety and Health Report – Pursuant to G.S. 143-583, the State Human Resources Commission is required to report annually to the Joint Legislative Commission on Governmental Operations on the safety and health activities of State agencies, compliance with the Article 63 of Chapter 143, and the fines levied against State agencies pursuant to Article 16 of Chapter 95 of the General Statutes.

FY 2014 pdf format

North Carolina State Employees Workplace Requirements Program for Safety and Health Reports listed below summarizes the safety and health program activities of State Departments and Universities in compliance with Article 63 of Chapter 143 of the General Statutes).     

2008 pdf format     2009 pdf format    2010 pdf format     2011 pdf format    2012-2013 pdf format     2014 pdf format         


Safety Forms

OSHA Occupational Injury & Illness Recordkeeping FormThis link provides all the information needed in order to document and answer OSHA reporting questions related to an accident/incident in the workplace. 

Safety Inspection Checklist

Safety Orientation Checklist

Employee Ergonomic Self-Evaluation Form

Incident Investigation and Reporting Program

  • NC Employee Incident Report: This report must be used to report the incidents and near hits immediately to supervisors and no later than 24 hours after the incident. An incident is an undesired event which resulted in personal injury, damage to property, or loss of process or material. A near hit is an incident where no property was damaged and no personal injury sustained, but where damage and/or injury easily could have occurred given a slight shift in time or position.
  • NC Supervisor Incident Investigation Report: Supervisors will work with staff (investigation team) and the Program Administrator to determine the direct and root causes of the incident. Then the investigation team will determine corrective actions to address each of these causes and implement these corrections. The Supervisor will obtain the Managers signature and forward to the Program Administrator.
  • NC Witness Statement Form: Within 24 hours, the manager or supervisor will begin interviewing employees who were present prior to or after the incident and others who are familiar with the related process or work practices. All individuals will be interviewed separately and must complete this form.
  • NC Annual Incident Evaluation Report: The Program Administrator must review the program annually and submitted this form to senior management.