Incident Report Forms | Risk Management | BYU-Idaho

# Reports and Requests

Incident Report Forms for employee work-related, Non-work related, Motor vehicle, University property, and Hazardous material form's.

## Bodily Injury and Property Damage Reports

Work Related and Non-Work Related Injury Report

Any incident resulting in any injury to an employee, regardless of the severity, is to be reported to the Safety Office within 48 hours for minor injuries; 24 hours for serious injuries, and 2 hours for hospitalization or death. Completing and submitting this form aids in the initial investigation.

Injury Report

Motor Vehicle Incident Report

If you are involved in a motor vehicle collision while driving a BYU-Idaho fleet vehicle, complete a Motor Vehicle Incident Report and submit it along with the photographs to Risk & Safety Management.

Motor Vehicle Report

University Property Damage Report

Use this form to report lost, stolen or damaged university owned property, except for motor vehicles.

University Property Damage Report

## Hazardous Material Reports

Chemical Spill Report

Minor spills are to be cleaned up immediately and then reported to the Safety Office within 48-72 hours of the incident. By submitting this form the Safety Office will be notified. 
 
Major spills are to be reported immediately to the Public Safety Office at (208) 496-3000. Dispatch will send an officer to investigate and will also notify the Safety Office where spill control and cleanup materials will be gathered and brought to the scene. Please complete the Hazardous Material Spill form within 24 hours after the incident.

Chemical Spill Report

Hazard Safety Concern Report

Students and employees are encouraged to report hazard or safety concerns by submitting a Hazard/Safety Concern Notification. If you see or hear something that could potentially harm someone, cause damage to property or may have an environmental impact, please complete and submit this notification form.

Hazard Safety Report

Bloodborne Pathogen Incident Report

We are required to track the occurrence and treatment of needlestick incidents, in accordance with Federal regulations; therefore, this report must be filled out for all persons -- student, faculty, and staff. It is to be submitted within a few hours after the incident. A copy of the report is also automatically submitted to the Student Health Center for their records. 
 
The form needs to be submitted regardless of the type of needle stick, and whether the needle is clean or dirty.

Bloodborne Pathogen Incident Report

## Fire Safety Requests

Room Capacity Review

Room Capacity Review

Fire Safety Training Request

Fire Safety Training Request

Fire Watch Request

Fire Watch Request

Request for Fire System Impairment Inspection

This form is used by the Building Coordinators to have the first aid kits restocked. The request is to be submitted on a quarterly bases, depending on the need.

Fire System Impairment Inspection

Report Fire Extinguisher for Replacement

Report Fire Extinguisher for Replacement

## Other Service Requests

Biohazard Container Pickup-Disposal Request

Biohazard Pickup-Disposal Request

Electronic Waste Disposal Request

Electronic Waste Disposal Request

Hazardous/Environmental Waste Disposal Request

Hazardous/Environmental Waste Disposal Request

First Aid Kit Refill Request

This form is used by the Building Coordinators to have the first aid kits restocked. The request is to be submitted on a quarterly bases, depending on the need.

Refill Request

New First Aid Kit Request

New First Aid Kit Request

Light Bulb Disposal Request

Light Bulb Disposal Request