Non-Employee Injury Report

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This report is used to document incidents involving individuals who are not employees of the university but are present on university premises or involved in university-sponsored activities. This serves as a tool to collect information about incidents, accidents, or other occurrences that may impact the safety or well-being of non-employees, such as visitors, guests, contractors, or event attendees.

Contact Information:

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address

Affiliation

Incident Details:

Date of Incident

Time of Incident

Location of Incident (Please Be Specific)

Were any of the following contacted?

Department of Public Safety (SLU DPS)

Police

Supervisor

Ambulance

Other

How did the incident occur?

What activity was being done at the time of the incident?

Did the incident lead to an injury?

Please describe the injury

Was medical treatment needed?

Witnesses:

Was there a witness?

Witness 1 First Name

Witness 1 Last Name

Witness 1 Phone Number

Witness 1 Email Address

Was there another witness?

Witness 2 First Name

Witness 2 Last Name

Witness 2 Phone Number

Witness 2 Email Address

Other Fields

Your name

Your email address

Verification Code