Forms

Incident Report:
An Incident Report is filed for any incident happening on campus involving a non-employee and is not covered by Workers' Compensation. This applies to visitors, students that are not at work when the incident occurs, and volunteers. This form is available by clicking on the link above.

Employees are expected to report if they're injured or potentially injured while working by submitting the First Report of Injury and Occupational Disease form.

Near Miss Incident:
The Report of Unsafe or Unhealthful Working Condition or a Near Miss Incident form is provided for the assistance of employees at MSUN and is not intended to constitute the only method by which a report may be submitted. A near miss is defined as an incident that has the potential to cause serious injury or property damage. The incident reveals a physical condition or employee action that could lead to future serious injury or property damage if not corrected. This form is available by clicking on the Near Miss Incident link above.

Volunteers:
Volunteers are not covered under Worker’s Compensation. If an accident happens, file an Incident Report. The person is covered under their own health insurance.

Other forms:
Be sure to read the Procedures page for information on the following forms: