All injuries must be reported immediately. Supervisors must complete this incident report and submit it to EHRS within two business days. 

Please note, this is the form for ULAR.  If you are looking for the (unrelated) Accident/Incident report for FRES, go here.

Information on Employee Who Had Incident
Nature of Accident or Incident
(ex. burn to left hand, fracture to left ankle)
Witness Name
more items
Did employee receive a medical evaluation?
Preventive Actions
Check to certify: By submitting this form, you certify that this information is true and correct to the best of your knowledge.