Times Union 2025

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4.8 out of 5

56 votes

The document is a report form for accidents or injuries occurring at SUNY Cobleskill, based on the State University of New York form CS-13 C2128-681. It includes sections for detailing the incident, victim information, nature of the injury, medical assistance provided, and witness details. The form is intended for use by students, faculty/staff, and visitors to report incidents accurately and ensure proper follow-up with safety and payroll offices.

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Click ‘Get Form’ to open the Times Union document in the editor.
Begin by entering the campus name and the date and time of the incident in the designated fields. Ensure accuracy for proper record-keeping.
Indicate whether the incident involved personal injury by selecting 'Yes' or 'No'. This is crucial for categorizing the report.
Fill out the victim status section, including their name, home address, and contact information. Be sure to print clearly for legibility.
Complete the employee information section if applicable, detailing job title, work schedule on the day of injury, and supervisor's name.
Injury information requires you to specify the general location of occurrence and nature of injury. Select all relevant options provided.
Finally, provide a narrative description of the incident in detail, including any witnesses' names and addresses. This helps in understanding circumstances surrounding the injury.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (56 Votes)

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