Injury Report

Do not use for Workers' Compensation or illnesses.
All injuries should be reported within 24 hours.

Please keep a copy of this form for your records. 

The asterisk ( * ) indicates a required field.

Information about the Injured

Injury Information

 

Program Participant?
Camp
WC Performance Group
Field Trip
Other
Status of Person at Moment of Injury
Student
Staff/Faculty
Visitor/Guest
Non-Student of WC

Other Information

 


NOTE: THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OF LIABILITY BY WESTMINSTER COLLEGE. 

If you have any questions, please contact:
Margaret Larsen
Gore Building, Room 213
801.832.2657
Fax: 801.832.3124