Updated: June 25, 2022
This form should be completed and submitted by an employee’s supervisor/manager in the event of an incident or injury. This form may also be used to report incidents like near misses, where there was no injury, but the potential for injury existed.
Where an employee has been injured, the supervisor of the employee must submit this form within 24 hours of the incident. Failure to report injuries which result in health care or lost time from work (other than the day of injury) may result in a financial penalty to the applicable department.
If you require medical care, please go to a health care provider. Occupational Health and Safety does not provide primary care, but only occupation-related consulting services.
Important Notes About eForm
- Ensure you have all details of the incident and personal information of the employee involved before starting the form.
- If some information is not available, submit what you have and provide the missing information to EHS (firstname.lastname@example.org) as soon as you have it.
- If information for a required field (e.g., phone number) is not available, enter placeholder number/text to complete the submission of the report (e.g., 111-111-1111) and note this in the free text section.
- Once the form is submitted, a copy of the report will be sent to the e-mail addresses provided on the form. If you do not receive a copy of the form, contact the EHS office.
- The eForm requires UTORid authentication (UTORid and password).