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Western Kentucky University
EMERGENCY ALERT SYSTEM:

WKU WEATHER ALERT:

ALL Thursday and Friday classes on all campuses are canceled. Online classes will proceed as scheduled. WKU offices will be closed on Thursday, with essential personnel reporting.

WKU Elizabethtown-Fort Knox campus will remain closed Thurs., Fri, and Sat., March 5-7.

Residence Halls remain open until noon Saturday. Bemis & Barnes have space for those who need to stay longer. Visit WKU Housing & Residence Life for more information.

The high school regional basketball tournament games scheduled for Wednesday night were canceled. Games will be rescheduled for Friday/Saturday. Follow WKU News for the latest updates. #WKUAlert

Environment, Health and Safety

Accident/Incident Report Form for Non-employees
     (including Students and Visitors)

Please follow these instructions for this form:

  1. Fill out form and check the information for errors
  2. If the form is correct, click the submit button below. For security reasons, this form can no longer be sent to you via e-mail.
  3. After submitting the form, a printer-friendly copy will display that you may print for your records.
  4. Alternatively, you may also Print and FAX a SIGNED copy to EH&S Department at 745-5037

PERSONAL INFORMATION

Name: (Last, First, M.I.):   Home Phone:  
Local (Home) Address:
    
WKU Student?  Yes    No
Visitor?  Yes    No

 

ACCIDENT INFORMATION

Date of Accident:   Time:   This accident/incident occurred:  On Campus     Off Campus
Specific location of accident:  
Activity in which the person was engaged at the time of the accident:  
Equipment, materials, apparatus, etc. that the person was using at the time of the accident:  
Property Damage:  
Witness(es):   Witness phone number(s):  
Nature of Injury:       Other:  
Body Part Injured:       Other:  
Details of Accident:
    
Initial Medical Treatment:        Other:  

 

SUBMITTED BY

Filer/Preparer's Name:   Title:  
Phone:   E-mail address:   Date Filed:  

 

 

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 Last Modified 9/24/14