Report an Injury, Incident or Safety Concern

Instructions: Please complete the following and click CONTINUE to report an incident.
If more than one person was injured, please submit a report for each person.

1. Select the information that best describes the incident:

    Injury/illness or possible injury/illness resulted from incident.
    Possible dangerous event or unsafe condition.

2. What is the affiliation of the person for whom this form is being completed?

3. Was a vehicle involved?      Yes   No