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Injury-Illness

Employee Injury Incident Report












To be completed by the supervisor to report the injury/occupational illness of an employee. Form must be completed within 24 hours or first working day after incident. Form must be printed, signed, and faxed or mailed to :

Environmental Health and Safety
ATTN: Injury/Illness Prevention Program
PO Box 6551
Morgantown, WV 26508
Fax: (304) 293-7257

Email to:
Carol.Wells@mail.wvu.edu
Amanda.Biddle@mail.wvu.edu

Student- Visitor Accident Report Form





To be completed by the student or visitor to report an injury. Form must be completed within 24 hours. Form must be printed, signed, and faxed or mailed to :

Environmental Health and Safety
ATTN: Injury/Illness Prevention Program
PO Box 6551
Morgantown, WV 26508
Fax: (304) 293-7257
Return to Work Notice
To be filled out by the supervisor when employee returns after being on leave due to an injury/occupational illness.

Office of the Vice President for Strategic Initiatives