[jpelletier]

Hi Kathleen-
Our incident report form is attached.
–Jeff

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Jeff Pelletier, MA, MBOE, LSSBB
Ohio Union Director
The Ohio State University
Columbus, OH
614-292-3290
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Original Message:
Sent: 02-28-2022 15:40
From: Kathleen Hurley
Subject: Incident Reports

Does anyone have an incident report template separate from their usual shift reports?  We are looking to institute incident reports for injuries, emergencies, and crime in the building.

——————————
Kathleen Hurley
Assistant Director, Finance & Operations
Wake Forest University
Winston Salem NC
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Incident report.pdf 239 KB PDF - Click to view

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[adam_0904]

Hi Kathleen,
Attached is the form we use. It is pretty basic, and serves to catch any major incident related details police/emergency services might miss when they come, as they are the primary information takers. Hopefully this helps.
Best,
Adam

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Adam Dunbar
Senior Associate Director – Student Affairs
University of Massachusetts Lowell
Lowell MA
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——————————————-
Original Message:
Sent: 02-28-2022 15:40
From: Kathleen Hurley
Subject: Incident Reports

Does anyone have an incident report template separate from their usual shift reports?  We are looking to institute incident reports for injuries, emergencies, and crime in the building.

——————————
Kathleen Hurley
Assistant Director, Finance & Operations
Wake Forest University
Winston Salem NC
——————————

[Deanna Cahoon-Draus]

Hi Kathleen,
Attached is our incident report form. I edited within the last year or so to not only include medical incidents (first side and the side that gets used most often) and but also other incidents. We don’t have other incidents very often, but nice to have when we need it!

For employee injuries, we have the Building Managers use this form initially and then the supervisor will fill out the other additional HR forms that can be informed by the Building Manager’s initial report.

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Deanna Cahoon-Draus
Building Operations Specialist
University of Wisconsin River Falls
River Falls WI
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——————————————-
Original Message:
Sent: 02-28-2022 15:40
From: Kathleen Hurley
Subject: Incident Reports

Does anyone have an incident report template separate from their usual shift reports?  We are looking to institute incident reports for injuries, emergencies, and crime in the building.

——————————
Kathleen Hurley
Assistant Director, Finance & Operations
Wake Forest University
Winston Salem NC
——————————

Accident & Injury Report (2).pdf 219 KB PDF - Click to view

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• Copy Download Link

[Jennifer Chapman]

Hello Kathleen,
I have attached a copy of the Google Form that our Student Building Managers use to report an Incident/complaint report while on shift. The notification that the form was filled out ready for review will be in that person’s inbox using a Google Form.?

Best,?
Jennifer

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Jennifer Chapman
Associate Director for Facilities and Operations
Virginia Commonwealth University
Richmond VA
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——————————————-
Original Message:
Sent: 02-28-2022 15:40
From: Kathleen Hurley
Subject: Incident Reports

Does anyone have an incident report template separate from their usual shift reports?  We are looking to institute incident reports for injuries, emergencies, and crime in the building.

——————————
Kathleen Hurley
Assistant Director, Finance & Operations
Wake Forest University
Winston Salem NC
——————————

VCU USC&A Incident_Complaint Report.pdf 78 KB PDF - Click to view

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• Copy Download Link

[Michelle Rucker]

We currently use a log in 7Point for ease of access for staff. Here’s the copied and pasted fields:

Please fill out this report and attach any necessary pictures, if any of these occur in the MU, SEC, Quad, Plaza or Cultural Centers.

– Accident*
– Medical emergency/Injury*
– Property Damage
– Building Policy Violation
– Public Disturbance
– Illegal Activity
– etc.

OSU Employee Workers Comp Information: https://drive.google.com/file/d/1LDlTvCUDoFztHyjLpzkJUZclCYZ8fTLQ/view?usp=sharing?

Log Entry Title*

Log Entry Upload (photos as needed)

What is your affiliation with Oregon State University?*

?OSU Employee

?OSU Student

?Campus Guest

Your name and email address for follow up questions?*

Location and time of incident:*

Give incident description:

Who else witnessed the incident? (Their name and contact information)

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Michelle Rucker
Assistant Director, Operations
Oregon State University
Corvallis OR
michelle.rucker@oregonstate.edu
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——————————————-
Original Message:
Sent: 02-28-2022 15:40
From: Kathleen Hurley
Subject: Incident Reports

Does anyone have an incident report template separate from their usual shift reports?  We are looking to institute incident reports for injuries, emergencies, and crime in the building.

——————————
Kathleen Hurley
Assistant Director, Finance & Operations
Wake Forest University
Winston Salem NC
——————————