Get Tufts University Accident/incident Report Form 2019-2025

This guide provides clear instructions for completing the Tufts University Accident/Incident Report Form online. Ensuring accurate reporting of accidents and incidents is vital for maintaining safety and compliance.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the date when the accident or incident occurred. Include both the date and the time, specifying AM or PM.
3. Indicate who was involved or affected by selecting the appropriate designation, such as faculty, staff, visitor, contractor, student, or student employee.
4. Provide the personal details of the individual affected, including their last name, first name, telephone number, and home address.
5. List the names and contact information of any witnesses to the incident, if known.
6. Select the campus where the incident took place (e.g., Boston, Medford, Grafton, Other) and specify the exact location.
7. Briefly describe the accident or incident, detailing the activities of the person involved prior to the event.
8. Identify the object, equipment, or substance that caused harm.
9. List any affected body parts and the injuries sustained.
10. Indicate the extent of medical treatment received, choosing from options such as none, first aid, medical, or unknown.
11. If treatment was given off campus, provide the name of the doctor, facility, address, and phone number.
12. Answer the questions regarding ambulance transport, emergency room treatment, and overnight hospitalization.
13. Supply information about the individual’s employment with Tufts if applicable, including job title, department, date of hire, and state of employment.
14. Note any lost time from work due to the incident and provide relevant dates if the individual has returned to work.
15. Enter the date of birth of the affected individual, and detail to whom the injury was reported, along with their name and title.
16. Complete the information for the person filling out the form, including their title, name, address, and telephone number.
17. Make sure to indicate the date the form is prepared and include the preparer's signature to validate the document.
18. Once all fields are filled out, save changes, download, print, or share the form as necessary.

Complete the Tufts University Accident/Incident Report Form online today to ensure timely reporting of incidents.