Mishap Reporting

Mishap Reporting


1. Initial Mishap Report


2. Download Mishap Report Form


3. E-mail Mishap Report Form to   



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.


What is a Mishap and Near-Miss?

A Mishap is defined as any unplanned event that results in personal injury or property damage.  There are different reporting proceedures for Mishaps depending on where it happened and if you are a Civilian or Military.  The details can be found below on this page.


A Near-Miss is an event that does not result in an injury or damage. However, it is very important that an near-miss be reported to the NPS Safety Office so that we can record an investigate near-misses to put corrections in place so they do not become a Mishap.  Information on how to report a Near-Miss can be found on our Near-Miss Reporting Page.



mishap process


Injury/Illness Treatment (Civilian Employees Only)

Injury Claims Process for Federal Civilian Employees Serviced by HRO Naval Postgraduate School. Employees who are injured on the job must immediately report every job-related injury or illness to their supervisor.

Supervisors must issue a Medical Referral (OPNAV 5100/9) (formerly called Dispensary Permit) to the employee to be treated at the Occupational Health Clinic. Employees are urged to contact the Occupational Medicine Clinic at 831-242-5332 for an appointment. Employees should then report to the Occupational Medicine Clinic, now in Building 4390 Parker Flats Cut-off Seaside CA 939555. Employees do not have to be treated at the Clinic but can elect to be treated by a physician of their choice (usually located within 25 miles of residence/work). If an Occupational Medicine physician is not available, employees can go to an Urgent Care Facility for treatment. Employees who sustain an on-the-job injury of such severity that requires immediate medical attention (severe lacerations, possible fractures and head/neck injuries) should be transported to the closest civilian emergency medical facility.

Employees who do not receive treatment at the Occupational Medicine Clinic should obtain a form CA-16, "Authorization for Examination and/or Treatment," from the Injury Compensation Office at HRO, Building 220, Hermann Hall. This form is only issued by HRO within 48 hours from the time of the traumatic injury.

To file a claim for an on-the-job traumatic injury, employees must complete for CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation." This form must be completed in its entirety by the employee and supervisor and forwarded to the Injury Compensation Office, Building 220, Hermann Hall within 2 workdays from the date the supervisor receives notice. The dispensary permit, CA-16 or a disability note from the treating physician must be attached to provide the work status. To file a claim for an Occupational Illness, employees must complete form CA-2, "Notice of Occupational Disease and Claim for Compensation." These forms are available on the HRO web page or from the Injury Compensation Office.

Employees are responsible for advising their physician that light duty may be available if unable to return to full duty. The supervisor will determine if light duty is available.

Employees who are unable to return to work due to a traumatic injury can elect Continuation of Pay (COP) if they are totally disabled and have supporting medical documentation. COP can be granted up to 45 calendar days from the date of injury. The date of injury is reported on the time sheet as Code LU for either 1 hour if the employee continued to work for the hours the employee was unable to work on the date of injury. This code is used only to identify the date of injury. Lost time after the date of injury is reported on the time sheet as code LT up to the 45 calendar day entitlement.

Employees/supervisors must notify the Injury Compensation Program Office, HRO at 831-656-2244 of the time of the injury ASAP.

Supervisors are also responsible for notifying their appropriate Safety POC of any mishap.

For further guidance employees/supervisors can contact HRO at 831-656-2244.

For details on The Federal Employees' Compensation Act (FECA), see the Department of Labor's Site for an Overview and Material Assistance.


Classifications of Mishaps:

Class A Mishap. Fatality or permanent total disability that resulted from a reportable injury or illness; or, a total cost of damages for DoD or non-DoD property of $2.5 million or more.


Class B Mishap. Permanent partial disability that resulted from a reportable injury or illness; hospitalization for inpatient care of three or more personnel as a result of a single mishap (i.e., for mishap reporting purposes only, inpatient care does not include individuals hospitalized for observation, diagnostic or administrative purposes that were treated and released); or, a total cost of damages for DoD or non-DoD property of $600,000 or more, but less than $2.5 million.


Class C Mishap. Nonfatal reportable injury or illness that resulted in the loss of one or more days away from work, not including the day or shift that the mishap occurred (i.e., a Lost-Time Case); or, a total cost of damages for DoD or non-DoD property of $60,000 or more, but less than $600,000.


Class D Mishap. A reportable event in which the resulting total cost of damage to DoD or non-DoD property is $25,000 or more, but less than $60,000; or, an on-duty injury or illness not otherwise classified as a Class A, B or C mishap (e.g., illness or injury that involves medical treatment beyond first aid, loss of consciousness, light or limited duty for military personnel or restricted work or job transfer for on-duty Navy and Marine Corps civilian employees)


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 5100.23H, Chapter 14,

OPNAVINST 5102.1E 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 online thru RMI (Risk Management Information) 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 RMI. 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 RMI 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


Forms and Publications: