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Minnesota Serious Injury Report Form 2026
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- Click ‘Get Form’ to open the Serious Injury Report in our editor.
- Begin with the CLIENT INFORMATION section. Fill in your first name, middle initial, last name, and date of birth. Select your gender and ethnicity from the provided options.
- Next, provide your address details. Indicate whether it is a temporary or permanent address and fill in the required fields such as city, state, and zip code.
- Move on to REPORTER INFORMATION. Decide if you want your identity to remain private and fill out your contact information including email and phone number.
- In the ADDITIONAL CLIENT INFORMATION section, check all applicable categories related to client status and legal representatives.
- Complete the SERIOUS INJURY INFORMATION section by entering details about the injury, including date, time, location, and circumstances surrounding it.
- Finally, review all entries for accuracy before submitting. You can easily save or print the completed form directly from our platform.
Start filling out your Serious Injury Report today for free using our intuitive online editor!
See more Minnesota Serious Injury Report Form versions
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An online form is an electronic application in which data is entered by the person filling it out for recording and further processing via predefined data fields. Such electronic forms can be found, for example, on websites or as attachments in e-mails.
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Online Application Form means the electronic sign-up form which is available on the Companys website (the websites) and which a prospective Client has to complete in order to become the Companys Client.
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Related links
Use this form to report to The Office of Ombudsman for Mental Health and Developmental Disabilities (OMHDD) pursuant to Minnesota Statute 245.92 and 245.94.Read more
The Death and Serious Injury reporting forms are downloadable here. please call 651-757-1800 or toll free 1-800-657-3506