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.
- Report all serious injuries and safety hazards to campus security ext. 3084, student affairs ext. 2232, and risk management office ext. 7052.
- Report all Incident/Accident within 24 hours.
- Individuals involved in, observing or discovering the Incident/Accident or property damage is responsible for completing this report.
- Be observant: attempt to get as much information as possible at the time of the Incident/Accident.
- Relate only to the facts on this form.
- 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.
- After form is completed, email or deliver this form to student affairs office at email@example.com or hand deliver a hard copy to:
Taylor Hall 301
1 Western Way
- 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.