Use the following forms to report injuries, incidents, or claims.
Submission of these forms does not constitute an admission of liability.
Use this form to report employee (full-time and part-time) injuries.
Any incident resulting in any injury to an employee, regardless of the severity, is to be reported to the Safety Office within 48 hours for minor injuries; 24 hours for serious injuries, and 2 hours for hospitalization or death. Completing and submitting this form aids in the initial investigation.
Use this form to report student, visitor and guest injuries that occur either on campus or in a BYU-Idaho sponsored off-campus class activity, including athletics, leadership training, field trips, laboratory work, etc.
(Please do not use this form to report injuries that occur at church activities, including FHE, service projects or other meetings.)
If you are involved in a motor vehicle collision while driving a BYU-Idaho fleet vehicle, complete a Motor Vehicle Incident Report and submit it along with the photographs to Risk & Safety Management.
(Please note: It's best to use Adobe Acrobat DC to complete this form.)
Use this form to report lost, stolen or damaged university owned property, except for motor vehicles.
Minor spills are to be cleaned up immediately and then reported to the Safety Office within 48-72 hours of the incident. By submitting this form the Safety Office will be notified.
Major spills are to be reported immediately to the Public Safety Office at (208) 496-3000. Dispatch will send an officer to investigate and will also notify the Safety Office where spill control and cleanup materials will be gathered and brought to the scene. Please complete the Hazardous Material Spill form within 24 hours after the incident.
When you notify Public Safety, please be prepared to provide the following information:
- Your name
- The location of the spill
- Name(s) of the spilled material(s)
- The approximate amount of the spilled material(s)
- Any reactions taking place?
- What is being done to contain the material, if liquid?
- Is the area blocked off so that others are not contaminated?
- Were people evacuated from the area?
The more information you can provide the better prepared we will be when the spill is cleaned up and reports are made to the various Federal and State agencies.
The Safety Office will investigate and may, at times, ask the Public Safety office to assist when appropriate.
We are required to track the occurrence and treatment of needlestick incidents, in accordance with Federal regulations; therefore, this report must be filled out for all persons -- student, faculty, and staff. It is to be submitted within a few hours after the incident. A copy of the report is also automatically submitted to the Student Health Center for their records.
The form needs to be submitted regardless of the type of needle stick, and whether the needle is clean or dirty.
Students and employees are encouraged to report hazard or safety concerns by submitting a Hazard/Safety Concern Notification. If you see or hear something that could potentially harm someone, cause damage to property or may have an environmental impact, please complete and submit this notification form.
This form is used by the Building Coordinators to have the first aid kits restocked. The request is to be submitted on a quarterly bases, depending on the need.
In cooperation with the EPA's regulations governing spill prevention, this monthly checklist has been generated to aid in compliance with our Spill Prevention Control and Countermeasure Plan.
If you have any questions concerning the forms posted on this site, please contact the Risk & Safety Management Office at (208) 496-5606 or at firstname.lastname@example.org.