Incident Notification

Notifying Person's Contact Info

Note:

This incident notification form may be completed anonymously.
If you provide contact information, we will only contact you if we need additional information.

Notifying Person's UT EID

Notifying Person's Affiliation *

Notifying Person's Department * Do you work for one of these departments? If not, please select Other.

Notifying Person's Name

Notifying Person's Email

Notifying Person's Phone

Incident Information

Upload Files

Note:

You can upload multiple times but cannot delete any uploads. Files are uploaded when form is successfully saved.

Selected File

Choose File Any file uploaded must not exceed 20MB. (File Types: jpeg, jpg, png, heif, heic, pdf)

Note:

If this is a workers compensation claim, contact your supervisor within 24 hours to complete additional paperwork.