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Incident and Near-Miss Reporting Form

Incident and Near-Miss Reporting Form

University employees, students and others (volunteers, visitors, etc.) should use the following form to report an incident or near-miss.  Non-employees should use the following form to report an injury.  University employees (including student employees) should report all illnesses or injuries to HR using the Employee Illness and Injury Report.  An incident is when something happened that caused harm or damage, whereas, a near-miss is something happened but no harm or damage was caused.  This form will be sent to Environmental Health and Safety and is a confidential report. 

CONTACT

Audit, Risk & Compliance

St. Mary's Hall
300 College Park
Dayton, Ohio 45469 - 1642
937-229-4502
Email