University of Alberta Incident Report

NOTE: For emergencies or imminent danger please contact 911 or 780-492-5050

Please answer as accurately as you are able. Your answers will be used to
a) provide you with the best support possible following an incident
b) provide our community with valuable information, and
c) to comply with relevant legislation.
While all personal information will be protected, this is not a confidential form.

For assistance completing this form, please e-mail ehs.info@ualberta.ca

If you are completing this form on behalf of someone else, please answer as that person wherever possible. If you do not know the answer to a question, please state that you do not have the information.

For SUPERVISORS:
IF you are the SUPERVISOR, modifying an incident that has previously been entered, click through to Question 44, change the answer to Yes, and proceed through the rest of the form

NOTE: For emergencies or imminent danger please contact 911 or 780-492-5050