FSJC Student Fatality Checklist

Title Page

Checklist

First 2 Hours

Obtain full and detailed report regarding circumstances of death: • Where did the death occur? • How did the student get there? • What was he/she doing there? • Was he/she on pass? • Who was present when the death occurred? (gather witness and first responder statements)
Determine if the student is in Active or Leave status.
Notify Center Nurse Manager and have them contact your CMHC and the Regional Mental Health Specialist Health and Wellness Manager Desk Reference Guide
Notify Department of Labor Job Corps Regional Office by telephone or text messaging, and by e-mail PRH 5.4 Significant Incidents, R3(a) Incidents Requiring Immediate Contact with the Appropriate Regional Office
Notify Forest Service Job Corps National Office

Contact OSHA to report the death Link to contact OSHA field offices organized by state: https://www.osha.gov/contactus/bystate In accordance with 29 CFR 1904.39(a), OSHA reporting is required within 8 hours, PHR requirement is 6 hours PRH 5.4 Significant Incidents, R4 Incidents That Require Occupational Safety and Health Administration (OSHA) Notification
Submit an initial SIR PRH 5.4 Significant Incidents, R2(a) Reportable Events
Within 6 hours, notify Jobs Corps’ Division of Facilities and Asset Management Division of Facilities, Acquisition, and Maintenance (DFAM) (202) 693-3774 PRH 5.4 Significant Incidents, R4 Incidents That Require Occupational Safety and Health Administration (OSHA) Notification
Provide student’s identified point of contact information to emergency responders and ensure they have notified the student’s family/emergency point of contact.
After family notification, notify students and staff and arrange for counseling.
Complete and submit a CA-6 in ECOMP or eSafety (if student was in AD status)
Notify OWCP and send a copy of CA-6 and any other medical documentation you have. Contact Heather Edmonds for assistance with OWCP PRH 5.1 Program Management, R40 FECA/OWCP

Notify Safety Manager to begin assembly of After Action/Investigation team.
Prepare official records for delivery to DOL Job Corps National Office. Records should include: • All training records including CSO and dormitory files • Copy of the SIR submission • Copies of all CA forms and correspondence relating to the status of OWCP claims and/or performance of duty determinations (sealed health record) • Death certificate, if available; otherwise, forward death certificate to the Job Corps National Office as soon as it is available (sealed health record) • Autopsy report, if available (sealed health record) • Medical/coroner's report and chemical analysis report of all body fluids/tissues, if applicable (sealed health record) • Medical Files (sealed health record) Copies of any subsequent correspondence relative to the case or its claim status with OWCP should be sent to the Job Corps National Office for review and inclusion in the health record. PRH 6.4 Records Management, R19 Student Death
Consider arrangements for center memorial service and CARE TEAM support.

Within 10 days mail the deceased student's complete official student personnel record, including the sealed health records. Use certified mail or overnight delivery. Cassandra Thomas National Wellness Unit Office of Job Corps Rm N-4507 200 Constitution Ave, NW Washington, DC 20210 Phone: 202-693-3933 Email: thomas.cassandra@dol.gov PRH 6.4 Records Management, R19 Student Death