Student Incident Report

Instructions for Completion of Incident/Injury/Property Damage Report

To be completed by Student/Witness/Other

This is not a report for on-the-job injuries. Use the first report of injury from provided by the HR office.

  1. Report all serious injuries and safety hazards to campus security ext. 3084, student affairs ext. 2232, and risk management office ext. 7052.
  2. Report all Incident/Accident within 24 hours.
  3. Individuals involved in, observing or discovering the Incident/Accident or property damage is responsible for completing this report.
  4. Be observant: attempt to get as much information as possible at the time of the Incident/Accident.
  5. Relate only to the facts on this form.
  6. The Student Affairs Office will review this Incident/Accident report and will submit it to the Risk Management Manger with any recommendations for action, if necessary.
  7. After form is completed, email or deliver this form to student affairs office at gpierson@western.edu or hand deliver a hard copy to:
    Taylor Hall 301
    1 Western Way 
    Gunnison, CO
     
  8. Once Student Affairs reviews the report, it will be determined if a student Incident/Accident Analysis form will need to be filled out by the department head.