Non work related injury form 2026

1. Click ‘Get Form’ to open the non work related injury form in the editor.
2. Begin by filling in the 'Name of Injured' and 'Age' fields. Ensure accuracy as this information is crucial for processing.
3. Provide your 'Address' and 'Telephone' number for contact purposes. This helps in case further information is needed.
4. Select the appropriate 'Gender Identity' and 'Status' (Student, Employee, Visitor) to categorize the injured party correctly.
5. Record the 'Date of Accident' and 'Time of Day'. This information is essential for documentation and follow-up.
6. Indicate if UC Police were called and whether the injured person was transported to a hospital. If yes, specify the hospital's name.
7. In the 'DETAILS OF ACCIDENT' section, provide a thorough description of what occurred, including environmental factors that may have contributed.
8. Describe the nature of the injury in detail under 'DESCRIPTION OF INJURY', specifying which part of the body was affected.
9. Document any first aid measures taken prior to medical treatment in the 'DESCRIPTION OF ASSISTANCE RENDERED' section.
10. Complete the report by filling in your department name, your details, and those of any reviewing department representative before submitting it.

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