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1. Click ‘Get Form’ to open the Student Injury/Exposure Report in the editor.
2. Begin with Part 1: Instructor Statement. Fill in the STUDENT NAME, DATE & TIME OF INJURY/EXPOSURE, LOCATION OF OCCURRENCE, COURSE TITLE AND INSTRUCTOR NAME, and a DESCRIPTION OF INJURY/EXPOSURE.
3. If applicable, indicate whether the student has declined medical treatment by adding instructor’s initials in the designated area.
4. Complete the section for INSTRUCTOR’S RESPONSIBILITY by following the outlined steps for serious or minor injuries and ensure all necessary notifications are made.
5. Proceed to Part 2: Student Statement. The student should fill in their details including STUDENT ID #, MAILING ADDRESS, PHONE NUMBERS, and repeat the injury/exposure information.
6. The student must also indicate if they decline medical treatment and provide a reason if applicable before signing and dating the form.

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