Forms for Reporting Injuries
Work-Related Injuries and Illnesses for Employees (includes student employees):
The "Workers Compensation Report of Injury" form must be completed.
Once completed, sign the Employee Certification section (the form may be completed
electronically or on paper, but must be printed and signed). Submit the completed form to your Supervisor or other person authorized by your
department to sign the Employer Certification. Do not wait to turn in the form. If your supervisor is not available, please submit the form to Human Resources. If you need assistance call Christian Carter, 307-766-2290.
If a work-related injury meets any of the following criteria, the "UW First Report of Accident/Incident" must also be completed. Once completed, send the form to the UW Risk Management Office.
UW First Report of Accident/Incident
For injuries/incidents (including employee injuries) involving:
- a motor vehicle being used for university business
- damage to university property
- injury to a third party
- Student Injuries and incidents (not UW employees)
Reporting to Other UW Committees:
You may need to report the injury or incident to other UW committees such as the UW Institutional Animal Care & Use Committee (IACUC), Institutional Biosafety Committee (IBC), or Radiation Safety Committee (RSC).
- You may be needed to provide expertise, assistance, or advice regarding the injury or incident.
- Further UW investigation and reporting may be required to be submitted to other State
or Federal agencies.
Additional Injury Reporting Resources
Note: for some situations, multiple forms are required.
- Animal Research
- Biological Agent Exposure, Spill, and Disposal Instructions
- Biosafety Incident Reporting Form
- Chemical Hygiene Plan (Laboratory Safety, OSHA)
- Hazardous Materials Spill Emergency Response Plan
- Human Subjects Research
- Laser Safety Plan
- Radioactive Materials Safety Plan
- X-ray Safety Plan
Links to Incident Response Procedures
- Accidental Spill Prevention and Control Plan
- Animal Research
- Biological Agent Exposure, Spill, and Disposal Instructions
- Biosafety Incident Reporting Form
- Hazardous Materials Spill Emergency Response Plan
- Human Subjects Research
- Laser Safety Plan
- Radioactive Materials Safety Plan
- X-ray Safety Plan
- More Procedures on the A-Z index
Questions?
For questions regarding injury and incident reporting, contact:
- Human Resources, 766-4220
- UW Safety Office, 766-3277
- Research and Economic Development – 766-5353
- Risk Management – 766-6787