University of Toronto
Workplace Accident/Incident Report Form
This form should be completed and submitted by an employee’s supervisor /manager in the event of an incident or injury. 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; such as how your work might affect your medical condition, or vice-versa.
This form may also be used to report incidents like near misses, where there was no injury, but the potential for injury existed.
Please ensure that you have all of the details of the incident and the personal information of the employee involved before you start to complete the form. If some information is not available when you complete the form, please submit what you have and submit further information as soon as you have it. If you do not have information for a required field e.g. phone number, insert any number to complete the submission of the report (111-111-1111) and note this in the free text section.
Once submitted, a copy of this report will be sent to the e-mail addresses that you provide on this form. If you do not receive a copy of the form please contact our office as your submission may have failed.
***Please note the following form requires UTORid authentication.
If you are having trouble with your UTORid please visit the UTORid Account Management webpage.
If you are still having trouble with your UTORid after 12 hours of the incident occurring or being reported please contact our office at 416.978-4467 or firstname.lastname@example.org.