Get California State University Fresno Report Of Incident Or Accident
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How to fill out the California State University Fresno Report Of Incident Or Accident online
Filing the California State University Fresno Report Of Incident Or Accident online is essential for documenting any university-related injuries or illnesses. This guide will provide you with a clear and supportive step-by-step process to ensure you complete the form accurately and efficiently.
Follow the steps to successfully complete the form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Section 1, indicate your relationship to the university by selecting only one option: Student, Volunteer, Visitor, or Contractor. Additionally, confirm if a Fresno State Police report was made by selecting Yes or No.
- Move to Section 2 to specify the type of incident. You can choose from Injury, Illness, or Other (e.g., Vehicle, Near Miss, Dangerous Condition, Exposure Incident). Please select only one option.
- In Section 3, provide the involved person's information. Fill in the First Name, Last Name, Street Address, City, State, Zip, and Email. Additionally, include the Work Phone and Cell Phone number. Indicate the person’s gender and if they are under 18 years old by selecting Yes or No.
- Proceed to Section 4 to provide details about the incident. Enter the Date of Injury/Illness, Time (AM/PM), and Location. There is a reminder to fill in the second page regarding the description of the incident. Include the Name(s) of Witnesses along with their Address and Contact Telephone.
- If the incident resulted in an injury or illness, answer the additional questions asking if the individual received medical treatment in an emergency room, was hospitalized overnight, or received treatment beyond basic first aid. Select Yes or No for each of these questions.
- In Section 5, document the Hospital/Clinic information, including the Name of Facility, Address of Facility, Treating Physician, and Phone Number.
- Complete Section 6 by entering the Reporting Individual's information. Include the Reporting Employee’s Name (print or type), Telephone, Department/Office, Email, and Date.
- Make sure you have filled out the second page or back page regarding the description of the incident, stating only the facts. Attach an additional sheet of paper if necessary.
- Once you have verified that all sections of the form are completed, you can save your changes, download the form for your records, print it, or share it as needed.
Complete your report online to ensure timely processing and confidentiality of the information.
Related links form
To report an accident to the California DMV, begin by filling out the necessary forms, which include the Report of Traffic Accident Occurring in California (SR 1). Include clear details about the accident. If applicable, refer to the California State University Fresno Report Of Incident Or Accident form to maintain consistency in your incident documentation, especially if it occurred on campus.
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