Employee Injury or Illness Report

Service Overview

If you have been injured or become ill from a work-related cause complete this form documenting the circumstances within ONE BUSINESS DAY regardless of whether you seek medical treatment. 

If seeking medical treatment, complete the following and attach at the end of this form:

First Report of Injury (FROI)

Medical Release Form 

Available To

  • Faculty
  • Staff
  • Student employees

Related Services

Supervisor Statement of Employee Injury or Illness Report

Witness Statement of Employee Injury or Illness Report

 
Submit

Details

Service ID: 43084
Created
Thu 4/16/20 7:39 PM
Modified
Mon 11/21/22 10:12 AM