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Injury and Illness Forms

In the event of an employee accident, incident or exposure, the injured or exposed person's supervisor must complete and submit an‌ SVSU Employee Incident Form (114kB)

Nonemployee incidents also require a Non Employee Injury or Illness at Work (71kB)

If the injury involves a sharp object, MI/OSHA requires additional reporting. Sharps Injury Log (154kB)

Other important information:

Time Limit
The incident report must be submitted within 24 hours of the occurrence.

Applicability
The incident report applies to all employees (full?time, part?time and temporary), as well as to all students, contractors and visitors on campus, whether or not the injured or exposed person received medical attention.

Who Signs?
The incident report must be accurately completed and signed by both the injured or exposed party and his or her supervisor. If the injured or exposed party is not a SVSU employee, the University Police should sign the incident report. Should it be difficult to obtain the injured or exposed party's signed portion, departments should submit the supervisor's or Police statement immediately, and the injured or exposed party's statement as soon as it is available.

Submit
For employees send or deliver the original to Human Resources, Wickes Hall 373. For non-employees send or deliver to Business Services, South Campus A. Retain one copy for department files.