Injury Report Form

Reports should be filled out immediately after an injury occurs.

*Indicates a required field. If you are unable to obtain information, enter N/A.

Type of Member: *
During what kind of activity did this injury occur? *
Location of injury (select all that apply): *
Side of Injury:
Were University police called? *
Was an ambulance called? *
Was the member transported to the hospital? *
Was the On-Duty Director called? *

If University Police or an ambulance were called, please remember to call the On-Duty Director at (804) 335-6791.