Location of Accident*
Please provide street address or closest landmark, when possible.
Accident Description*
Describe what happened, how it happened, factors leading to the event, etc. Be as specific as possible. If a University vehicle was involved, please include the license plate number.
Description of Injury*
Please describe the injury (laceration, sprain, etc.), the part of body injured, and any other information known about the resulting injury(ies).
Witness Information
Provide names, phone numbers and email addresses of witnesses, if present.
Police report number
Complete only if police were notified (Campus Safety & Police, Elon Town Police, Burlington Police, etc.)
Describe restrictions
Employees must provide return to work restrictions to supervisor and Risk Management and Insurance. Employees must be approved to return before resuming job duties.