Employee accident form for doctor 2026

1. Click ‘Get Form’ to open the employee accident form in the editor.
2. Begin by filling out Part 1 – Employee Identification. Enter your name, home mailing address, department, and supervisor's name. Ensure you check the applicable campus box and provide your unique ID or Banner ID number.
3. Continue with your birth date, gender, hire date, work phone, job title, and time at your present position. Specify if the incident occurred on university property or business.
4. In Part 2 – Injury or Illness Information, document the date and time of the incident. Describe the injury and body parts affected clearly. Include details about what you were doing when the injury occurred.
5. Indicate whether you were using safety equipment at the time of injury and specify any witnesses. If medical treatment was sought, ensure that Part 3 is completed by a health care provider.
6. Once all sections are filled out accurately, review your entries for completeness before submitting. Follow the submission instructions to scan and email the form to injuryreport@listserv.miamioh.edu.

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