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:
Available To
- Faculty
- Staff
- Student employees
Learn More
Medical Release Form (.pdf)
Related Services
Supervisor Statement of Employee Injury or Illness Report
Witness Statement of Employee Injury or Illness Report