Accident, Injury, Incident Report Form

Report an accident, injury, or incident in a teaching or research lab in the Department of Chemistry

• EVERY accident, injury, near-miss or safety incident in a Chemistry Teaching or Research lab should be reported through the INCIDENT REPORTING SYSTEM (click Yes below).

  Did the incident occur while working in the Department of Chemistry?

  Yes  

Scroll down to complete your entries, then click on the SUBMIT button.  Safety personnel in the department will be notified automatically, and the report will be logged into a database for posterity.

If the incident did not require the injured person(s) to be transported off-campus, then no further action is needed.

If the incident resulted in an injury that required off-site medical attention, please also do the following:

Paid employees of Purdue University must 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 works best with Firefox (page won't print or send using Google Chrome).

NOTE: Chemistry = Department 2084

In case of an injury, administer first aid and seek medical care first.  Complete the forms as soon as possible (within 24 hours) after the injury is stabilized or being treated at an off-site care facility.

If injuries did not require off-site medical attention, please DO NOT submit the FROI form, as each one costs the University time and money.