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Incident Report Form

Data collection is an important part of our safety program. Reported information helps identify trends, investigate problem areas and look for corrective measures or training opportunities. The incident report form helps in the collection of this information. The form should be filled out for college related incidents. This includes:

  • Work/college related illness or injury (no matter how small)
  • Safety incidents (such as vehicle accidents, fire, or other emergencies)
  • Near-misses (such as a file cabinet falling and almost hitting someone) 

The form should be used for students, visitors, contractors, faculty, and staff. In short, if it happens on our campus to anyone on our campus, it should be reported.

The form can be located at the HR forms web site or by following the link:

Please take the time to become familiar with this form. If you are an employee reporting a work related injury or illness, send a copy to the Emergency Management/Safety Coordinator and to HR. All other incidents should be sent to the Emergency Management/Safety Coordinator only. This should be done within 48hrs of the incident.