Incident Notification Form
Instructions: All injuries involving Faculty, Staff, students or visitors of East Carolina University are to be reported to the Office of Environmental Health and Safety (EH&S). Please fill out information for this incident. When completed click submit. The form will be emailed to the EH&S Program Administrator for review. The EH&S Program Administrator will respond with additional instructions. Direct any questions to EH&S at 252-328-6166.
Email Information

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CC:

lewisp@ecu.edu

Subject:

East Carolina University First Report of Injury

Send From

Location:


Completed By:


Completed By Email Address:

Identify the Person

Employee Name:


Describe the Case

Date of the injury:


Time of the Incident:



Where did the incident occur:



Description of the Incident:

301 Details






What was the injury or illness?


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