SFU Visitor or Student Health and Safety Incident Report Form
NOTE: If you are a paid SFU student, you must use the Workplace Health and Safety Incident form.

For health and safety incidents involving visitors or unpaid students at SFU, the following health and safety incident report must be completed by the involved or injured person within 24 hours of the incident occurring.

If the involved or injured person is unable to complete the report, it may be filled out by another individual with knowledge of the incident. In this case, the person must provide their name and contact information at the end of the report where indicated.

When submitted, a copy of the report is sent to the involved or injured person and the reporting individual (if applicable). EHS will review the report and contact the involved individual for further follow-up as required.

Involved or Injured Person

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If you require more space, you may click and drag the bottom right corner of the text box to increase size.
Outline any corrective and/or preventive actions recommended and if applicable indicate if they have been assigned or completed (e.g. Fix broken railing, FS service request submitted on [date] or Review proper lab technique with student, completed). Visitors, please leave this box blank.
Sep 18, 2020