Student Injury/Illness Reporting Form

This information will be used by EHS (Environmental Health and Safety) to follow up on student injury/illnesses that may have resulted from an uncontrolled hazard. This reporting tool is intended only for students that do not have "employee" status and which have not filed for workers compensation benefits, as described in the EHS SOP, On the Job and Student Injuries.

Injured/Ill Student Details
Incident Submitter Details
Is incident submitter different from student information provided above? Required
Incident Details
Incident Date Required
Time of Incident Required