Online Accident/Incident Report for Students, Contractors and Visitors
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University of Toronto
Student/Contractor/Visitor Incident Report Form

This form should be completed and submitted by a University of Toronto employee in the event of an incident or injury involving students, contractors or other visitors (including visiting students conducting research). For injuries involving employees go to the e-form for employees

This form may also be used to report incidents like near misses, where there was no injury, but the potential for injury existed.

Important Note:
This online form has a time limit of 20 minutes per page. 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 the the session has expired because you exceeded the allotted time to enter the data, please go back to the instructions page and the link for the e-form.

Once submitted, a copy of this report will be sent to the e-mail addresses that you provide on this form.

If you may need futher clarification/s, please refer to the sample webform and instructions page for more information.

Page 1 of 4
A. INCIDENT TYPE
Classification:
Healthcare neededFirst Aid
Minor Injury - no treatmentIncident - no injury
B. U of T representative/personnel (completing the report)
1. Full Name of U of T Representative:
2. Employing Department:
St. George
UTSC
UTM
Department and campus if unable to locate above:
3. E-Mail Address:
 
4. Email address of Department Chair or Director (to receive copy of form):
 
C. INJURED PERSON'S INFORMATION
1. Last name:
2. First Name:
3. Status at University
Contractor
Student
Visitor
4. E-Mail Address (to receive copy of form):
 
5. Home address:
6. Home or cell phone number:
 
8. Sex:
Male
Female
9. Dominant hand:
Left
Right
 

The University of Toronto respects your privacy and is committed to protecting confidentiality through the application of sound and secure practices. The University will protect all personal information in accordance with applicable privacy legislation. Personal information that you provide to the University is collected pursuant to section 2(14) of the University of Toronto Act, 1971 and may be used and disclosed for purposes that the University considers necessary for sound human resources administration and related activities, including, for example, those relating to recruitment, selection and hiring and payroll and benefits administration. If you have questions, please refer to www.utoronto.ca/privacy or contact the University Freedom of Information and Protection of Privacy Coordinator at 416-946-7303, McMurrich Building, room 104, 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8.
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