University of North Alabama Incident Report DIRECTIONS: This form is to be completed in ink by supervisors or cost center heads for accidents or incidents involving injury or potential injury to students or visitors on campus or during University-related activities. Complete this form as soon as practical after an incident or accident and deliver copies (no later than 24 hours following) to the Vice President for Student Affairs (UNA Box 5023) and the Vice President for Business & Financial Affairs (UNA Box 5003). GENERAL STUDENT/VISITOR INFORMATION: □ Injured person is: (check one) Student □ Visitor Name Student ID Number _ Name of parent/guardian/spouse _ UNA Box Academic Classification Age Local Address INCIDENT INFORMATION: Date of Incident or Accident _ Time _ a.m. or p.m. Location of Incident or Accident Name and phone number of witnesses to the incident or accident: 1. 2. 3. 4. Describe what happened: Nature of any injury (cut, puncture, burns, etc.) _
University of North Alabama Incident Report DIRECTIONS: This form is to be completed in ink by supervisors or cost center heads for accidents or incidents involving injury or potential injury to students or visitors on campus or during University-related activities. Complete this form as soon as practical after an incident or accident and deliver copies (no later than 24 hours following) to the Vice President for Student Affairs (UNA Box 5023) and the Vice President for Business & Financial Affairs (UNA Box 5003). GENERAL STUDENT/VISITOR INFORMATION: Injured person is: (check one) □ Student □ Visitor Name Student ID Number _ Name of parent/guardian/spouse _ UNA Box Academic Classification Age Local Address INCIDENT INFORMATION: Date of Incident or Accident _ Time _ a.m. or p.m. Location of Incident or Accident Name and phone number of witnesses to the incident or accident: 1. 2. 3. 4. Describe what happened: Nature of any injury (cut, puncture, burns, etc.) _