To be submitted by person injured on campus or by a witness of the injury. All injuries should be reported within 24 hours of the occurrence. DO NOT use this form to report Workers' Compensation-related injuries or illnesses (please follow instructions for WC incidents below).
Information about the Injured Person
Gender
Status
Injury Information
Program Participant?
Accident Location (required)

Suspected and known. Include details such as right/left, upper/lower, front/back, top/bottom.

Other Information

 


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

If you have any questions, please contact:
Dianna Jorgensen
Gore Building, Room 213
801.832.2657