Accident, Injury, Incident Report Form
Report an accident, injury, or incident in a teaching or research lab in the Department of Chemistry
- To report EVERY accident, injury, near-miss or safety incident in a Teaching or Research lab in our department, use the INCIDENT REPORT shown below. Once you click the SUBMIT button, safety personnel in the department will be automatically notified and the report is logged into a database.
- If you are a paid employee of Purdue University, you must also complete the Purdue University First Report of Injury (FROI) form. This includes faculty, staff, graduate students, visiting scholars, undergraduate research assistants, zero years and REU students. Efficient payment of medical insurance depends on completion of this step. The form is interactive and requires the use of Internet Explorer (page won’t print or send using Google Chrome).
- The First Report of Injury (FROI) form is available through DocuSign. The FROI form must be completed when a work-related injury occurs on the Purdue University campus.
NOTE: Chemistry = Department 1393
In case of an injury, administer first aid and seek medical care first. Complete the forms as soon as possible after the injury is stable or the individual has been transferred to a care facility.
A Purdue University Supervisor's Accident/Near-miss Investigation Form is provided for research directors and staff supervisors. In the case of a severe incident or near miss, this is also recommended.
Please fill out and submit this form: https://www.purdue.edu/ehps/rem/documents/forms/froi.pdf