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Accident Report

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HUMAN RESOURCES DEPARTMENT

Please complete the form below within 48 hours of the incident. Open forms with Google Doc to fill out online.

Required fields marked with an asterisk (*)
and please download and attach the following documents:

PERSONAL INFORMATION

First Name*

Answer Required

Last Name*

Answer Required

Email Address*

Answer Required

School/Location*

Answer Required

Employee's Supervisor Name*

Answer Required

Supervisor's Email*

Answer Required

Date of Incident

Answer Required

Attach Completed Employee Injury Report*

Answer Required

Choose a file or drag it here.

Attach Completed Injury Report-Statement of Witness

Answer Required

Choose a file or drag it here.

Attach Completed Injury Report-Statement of Supervisor*

Answer Required

Choose a file or drag it here.

For Internal Use Only

EPS Human Resources Department

Answer Required

Confirmation Email

Email Required