University Fire Department Response To
On-Campus Injuries/Fatalities

Facility Services should be notified in cases of fall accidents that may be due to conditions needing their attention (such as ice, holes in the ground, uneven sidewalks etc.). This will allow them to respond immediately and correct the problem, preventing any other injuries.

Once you submit this form, UAF Environmental Health & Safety (x5413) and State Wide Risk Management (450-8150) will be notified electronically.

Date of Incident:

Time of
Incident:

     Run Number:
    Did We Transport:
     What Happened:
DO NOT STATE PATIENT'S NAME OR ANY OTHER PRIVACY ACT INFO.
Where It Happened:
DO NOT STATE PATIENT'S NAME OR ANY OTHER PRIVACY ACT INFO.

Who Was Notified (check all that apply):

Fire Department
Environmental Health & Safety
Facility Services
Police