SFU Workplace Incident Report Form

The workplace incident report must be completed by the involved or injured person within 24 hours of the incident occurring.  If you are a visitor or unpaid student, please use the SFU Visitor or Unpaid Student Form instead.

If the involved or injured person is unable to complete the report, it may be filled out by the person's supervisor or another individual with knowledge of the incident. In this case, the person must provide their name and contact information at the end of the report where indicated.

Note: For the purpose of this reporting form, supervisors may be laboratory or course instructors, department managers, principal investigators in a research laboratory, department chairs, faculty supervisors, or anyone who directs the work relating to the incident. When submitted, a copy of the report is sent to the involved or injured person as well as his or her supervisor. EHS will review the report and contact the involved individual for further follow-up as required.

Involved or Injured Person Details:

Supervisor Details:

Incident Details:

Witness Details: