ESEM

ESEM

Accident Injury Report

 

Who should fill out a WMU Accident/Injury 311 Report?

The supervisor should complete the form with input from the injured employee, student, or visitor. All accidents and injuries of visitors, students, and employees while on WMU properties or while on scheduled WMU business off campus must be documented on the ESEM 311 form. Injuries of participants of collegiate athletics are the only exception for which completion of the 311 is not required.

When should you fill out a WMU Accident/Injury 311 Report?

The accident/injury report form (311) must be completed within 48 hours of the accident or injury and sent to the Division of Environmental Safety and Emergency Management

Why should you fill out a WMU Accident/Injury 311 Report?

An investigation of the accident or injury and completion of the 311 form by the supervisor with the injured employee, visitor, or student is an important tool for the university to determine possible causes of the accident and the measures to prevent a reoccurrence of a similar accident or injury.

The information on these forms is used to track accident trends, to determine if equipment or facilities need repairs, to establish worker’s compensation benefits, and to determine the safety training need for our university community.

Form and Instructions

  • Click here for instructions on how to complete the Accident/Injury 311 Form
  • Click here to obtain a printable copy of the Accident/Injury 311 Form
    • Note: You will need Adobe Acrobat Reader to open and print this form.

 

 

Environmental Safety and Emergency Management
Western Michigan University
Kalamazoo MI 49008-5418 USA
(269) 387-5590
patricia.holton@wmich.edu