UVM Incident Report

UVM Incident Report Form
Date	Time of Incident
Name of Person Reporting the Incident	Phone Number
Bodily Injury	Location of Accident
Name of Person(s) Injured



Describe What Happened	Emergency Medical Treatment Given
	Medical Treatment Administered by:
Describe What Was Done
	Was the person taken to the hospital?
	Name of Hospital
Were the Police Called to the Scene?
Name of Police Department	Name of Police Officer:
Property Damage: (including damage to another's vehicle)
Type of Property:	Location of Property:


Please submit this form to the UVM Department of Risk Management. All information will be kept confidential.

UVM Incident Report Form