JACKSONVILLE STATE UNIVERSITY ACCIDENT REPORT (For - jsu 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the injured individual in the designated field. Ensure accuracy for proper documentation.
3. Fill in the telephone number and address, including street, city, state, and zip code. This information is crucial for follow-up communication.
4. Indicate the job title if the injured party is an employee, along with the date and time of the accident/injury.
5. Specify the department where the incident occurred and provide details on how and where the accident took place.
6. List any tools or equipment involved during the incident to help identify potential hazards.
7. Describe the nature and severity of the injury clearly. If applicable, indicate whether there was exposure to blood borne pathogens.
8. If there were witnesses, provide their names and contact information for further investigation.
9. Document whether medical treatment was received and include details about healthcare providers if applicable.
10. Complete the form by signing it with your name, title, and date before submitting it to Human Resources.

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