PS Form 1769, Accident Report, Is Now Available in Electronic Form

Effective July 31, 2008, you must not use field-developed and field-generated electronic versions of PS Form 1769, Accident Report. The electronic version of PS Form 1769 on the United States Postal Service® Intranet (also known as Blue) is the only approved version.

Easily Access and Complete the Form Online

PS Form 1769 is now available on the Postal Ser­vice™ PolicyNet Web site in an easy-to-use, approved electronic format. With the electronic version, supervisors will be able to complete the form online, encrypt it, send it electronically, and print copies as needed. They will no longer have to fill out the form by hand in triplicate.

Protect Sensitive Information Before You Send the Form

PS Form 1769 contains personally-identifiable, sensitive data elements (e.g., Social Security numbers). The form must be encrypted before you e-mail it. Never save or store PS Form 1769 to any portable media device such as a thumb drive, flash drive, BlackBerry, or laptop.

The electronic version of PS Form 1769 is the same as the paper version it replaces with the following exceptions.

Updated Instructions

A tab, “Submission Instructions,” has been added to the approved electronic form. Updated submission instruc­tions include the following:

1. Review PS Form 1769 and OSHA 301, Injury and Illness Incident Report, online for accuracy and completeness.

2. Save the data to your computer.

3. Print a copy of PS Form 1769 and OSHA 301.

4. Sign PS Form 1769 in Block 56.

5. Place the signed PS Form 1769 and OSHA 301 with local OSHA recordkeeping files. Maintain for 5 years.

6. Use WinZip to encrypt PS Form 1769 (see the instructions in the next section), and then send an e–mail copy of the PS Form 1769, OSHA 301, and appropriate Job Safety Analysis (where required) to the servicing safety office, and your next higher level manager. In your message, include a phone number where you can be reached in case safety office per­sonnel need to speak with you.

7. If your PS Form 1769 was not completed and sent to the servicing safety office within 3 calendar days from the date of the accident, explain the reason for the delay in your message.

8. After printing a copy of PS Form 1769, senders and recipients must delete all of the following:

a. Electronic versions stored on their computers.

b. E-mail transmissions from the “Sent” and “Trash” folders.

c. Any copies in their BlackBerrys.

WinZip E-mail Encryption Instructions

1. Using My Computer or Windows Explorer, select the files or folders you want to encrypt and send by e–mail.

2. Position the mouse pointer over the file or folder, click the right mouse button and select WinZip, and then Zip and E-mail Plus from the shortcut menu. The WinZip Zip and E-Mail Plus dialog box appears.

3. Use the name of the file or folder you selected for your zip file name or select a different name by click­ing the Use this name field and entering the desired file name.

4. Select the Encrypt Zip File box; click OK. The Encrypt dialog box appears.

5. Type your password in the Encrypt dialog box; re–en­ter your password for confirmation.

6. Select 128-bit AES encryption; click OK.

7. Your file or folder is now encrypted; the Outlook compose message window appears with the encrypted file or folder as an attachment.

8. Add recipients, subject, and message.

9. Click Send.

10. Send a separate e-mail with the password to the recipients.

Privacy Act Statement

The following privacy statement is added to the instruc­tions to comply with federal policy requirements for using Web-based tools to collect information:

Your information will be used to record an accident. Col­lection is authorized by 39 U.S.C. 401, 410, 1001, and 1005. Providing the information is mandatory; failure to do so may result in disciplinary action. We may only dis­close your information as follows: in relevant legal pro­ceedings; to law enforcement when the USPS or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals under contract with USPS; to entities autho­rized to perform audits; to labor organizations as required by law; to federal, state, local or foreign govern­ment agencies regarding personnel matters; to the Equal Employment Opportunity Commission; and to the Merit Systems Protection Board or Office of Special Counsel.

Accident Report

The accident report section has the following changes:

  • Item 57 — the next higher-level manager is not required to sign the electronic version, but will receive a copy of the form.
  • Vehicle diagram — a supervisor who completes an electronic version of the accident report is not required to submit a diagram because a diagram of the accident is required on PS Form 1700, Accident Investigation Worksheet. (Completion of PS Form 1700 is required when investigating and document­ing a motor vehicle accident.)

Viewing and Completing PS Form 1769 Online

PS Form 1769 is available on the Postal Service PolicyNet Web site. To access it:

(The direct URL for the Forms Web site is