Accident and Injury Investigation Report

Accident and Injury Investigation Report

Report workplace or campus injuries promptly to ensure proper care, documentation, and follow-up investigation in support of a safe campus environment.

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INSIDE Campus Safety
Campus Police Emergency Procedures Health and Safety Campus Safety Contact
INSIDE Health and Safety
Accident and Injury Investigation Report Safety Committee Annual Security Report and the Jeanne Clery Act Safety Data Sheets

Accident & Injury

Reporting

This form is used to document any accident or injury involving students, employees, or campus visitors. All incidents must be reported to Human Resources within 24 hours to ensure timely review, appropriate response, and compliance with safety procedures. Please provide complete and accurate details to support a thorough investigation and corrective action process.

File a

Report

  • This field is for validation purposes and should be left unchanged.
  • This document must be submitted into Human Resources within 24 hours of incident.

  • Employee Section Only
    (To completed by the injured employee or his/her designee)

  • Complete for Employee/Student

  • Witnesses:

  • Causes of Accident/Injury:
    Mark all that apply as a Direct Cause:

  • Mark all that apply as a Contributing Factor:

  • Corrective Action Plan
    (include immediate, short term and long term plan)

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