Otis College of Art and Desgin

Faculty/Staff Incident or Injury

Note. This form is for reporting an incident that occurred to a faculty or staff member. To report an incident occurring to a student, please use the Student Incident Report.

Please conserve, only print when necessary. If you must print, please do so after submitting the form, the information will be displayed afterwards in a format better suited for printing. You will also receive an email containing all of the information.

(* Indicates a required field)

Reporter/Observer Information
 
 
 
 
 
Injured/Victim Information
 
 
 
 
 
 
Nature of Incident
Type of Incident (Check all that apply)
 
 
 
 
 
 
 
 
 
Please be as specific as possible including building, floor, area, etc.
 
 
 
Please describe in your own words what happened in as much detail as possible.
If applicable, describe any property damage/loss.
 
 
Individuals Involved
This may include witnesses.
 
  
  
 
  
  
 
  
  
 
Action Taken
 
 
 
Police Response
 
 
 
 
Fire Department Response
 
 
Paramedics Response
 
 
First Aid