Employee Incident Report - UCSF Fresno: Fill out & sign online

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Click ‘Get Form’ to open the Employee Incident Report in the editor.
Begin by filling out Section I: Employee Information. Enter your name, job title, phone number, department, and email address in the designated fields.
Move to Section II: Grievance/Complaint. Select whether you are filing a grievance or a complaint by checking the appropriate box.
In Section III: Grievance/Complaint Detail, clearly describe your grievance or complaint. Be specific about the issues you are facing and state your desired resolution.
If necessary, attach any additional documentation that supports your case using the attachment feature in our editor.
Finally, complete Section IV: Waiver of Rights by signing and dating the form to confirm your request for handling according to university procedures.

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Who should an employee report an incident to?

You should report any actual or potential health and safety hazards immediately to your supervisor. You do not need to wait for an inspection team to come by or for an injury to occur. In fact, health and safety legislation requires workers to report hazards to their supervisor.

How to do an employee incident report?

What to include in a work incident report The date and time of the incident. The name of the witness or author of the report. A detailed description of the events. The names of the affected parties. Other witness statements or important information. The result of the incident.

Are incident reports confidential in the workplace?

In many jurisdictions, these reports are considered confidential and are protected by law. This legal protection ensures that the incident details are accessible only to those directly involved in handling and investigating the case.

Where to report incidents at work?

All incidents can be reported online but a telephone service remains for reporting fatal and major injuries only - call the Incident Contact Centre on 0345 300 9923 (opening hours Monday to Friday 8.30 am to 5 pm).