Report Forms

The following forms are for use by the various departments across campus to help ensure compliance with codes and regulations and to aid in having the campus a safe place to study, work and visit.

Accident/Incident Reports

Insurance Claims are handled by the Risk Management Department.  To make a claim, click here.

 

Workers Compensation Incident Report Form

All incidents resulting in any type of injury to an employee are to be reported to the Safety Office within 48 hours for minor injuries, 24 hours for serious injuries, 2 hours for hospitalization or death. This form aids in that report ensuring that sufficient information is provided for the initial investigation.

 

Student Incident Report Form

This form is to be used to report all student injuries that occur either on campus or in a class related activity off campus. This does include athletics, leadership training, field trips, laboratory work, classroom, etc.

It does not include church activities, including FHE, service, meetings, etc. This is not to be filled out for any work related incidents.

 

Property Incident Report Form

This report is to be filled out and submitted if there is damage to university property as the result of an incident. This does not include normal wear and tear of equipment and materials.

It does not include vehicular accidents on the BYU-I campus. These are to be reported to the Campus Police Department ASAP.

It can be used to report an accident involving a company vehicle not on the BYU-I campus in addition to reporting the incident to the local authorities where the accident occurred.

 

Chemical Spill Report Form

Minor spills are to be cleaned up immediately and then reported to the Safety Office via written report, within 48-72 hours of the incident.

Major spills are to be reported by phone to the campus police dispatch as soon as possible. Dispatch will send an officer to investigate and will also notify the safety office where additional spill control and cleanup materials will be gathered and brought to the scene.

When notifying campus dispatch, please be prepared to provide the following information:

  1. Your name

  2. The location of the spill

  3. The chemical(s) spilled

  4. The approximate amount of the material(s) spilled

  5. Any reactions taking place

  6. What is being done to contain the material, if liquid

  7. Is the area corded off so that others are not contaminated?

  8. Are the students evacuated from the area?

The more information you can provide the better prepared we will be when it is cleaned up and the reports to the various agencies are made.

The written report of the spill is to be submitted to the safety office within 24 hours of the incident by the responsible party.

Any investigation will be conducted out of the safety office with use, at times, of the campus police when appropriate.

 

Bloodborne Incident Report Form

In order to track the occurrence and treatment of needle stick incidents in accordance with regulations, this report must be filled out by all persons, whether student, faculty or staff. It is to be submitted within a few hours of the incident. A copy of the form is automatically submitted to the Student Health Center for their records.

The report needs to be submitted regardless of the type of needle stick, clean or dirty.

Other Forms Accessed From this Site

Confined Space Entry Permit Form

A copy of this form is to be filled out and submitted to the Safety Office prior to entry into a designated Permit Required Confined Space. A copy of the permit is to be posted at the location of the confined space.

 

Hot Work Permit Form

a copy of this form is to be filler out and submitted to the Safety Office prior to any hot work outside of designated shops. A copy of the permit is required to be posted in the area of the Hot Work for the duration of the work.

Open Flame Permit Form

This form is to be completed/submitted and approved at least 48 hours prior to the use of an open flame in any university sponsored function.

 

Hazards Report Form

Students and staff are encouraged to report any potential safety concerns or safety suggestions by using the online Hazard Report form. This is an excellent opportunity for the campus community to become involved in safety and promote awareness.

 

Safety Notification Report Form

The Safety Office is charged with the responsibility of conducting periodic inspections of the BYU-Idaho campus and conveying safety information to respective faculty members or staff employees. Safety personnel have no enforcement authority and are not authorized to notify regulatory agencies regarding possible violations. This report is merely intended to enhance safety awareness and is to be used at the discretion of the recipient.

 

First Aid Kit Refill Form (pdf)

This form is used by the Building Coordinators to have their first aid kits restocked. It is to be submitted on a quarterly bases, depending on need.

If you have any questions concerning any of the forms listed on this site, please contact the Safety Office at harmstone@byui.edu or 496-2457.

 

SPCC Monthly Spill Source Checklist (pdf)

In cooperation with EPA's regulations governing spill prevention, this monthly checklist has been generated to aid in compliance with our Spill Prevention Control and Countermeasure Plan.