In the event of an exposure, needlestick, or work injury please complete the form below. If this is a life threatening or medical emergency, please call 911 or report to the nearest emergency room

• STEP 1: Complete and submit the first report of injury form below

• STEP 2: (For UT Employees and Students) Upon completion of this form, a document for e-signing will be sent via DocuSign/Smartsheet to the emails provided on the form for final review and signatures. THIS MUST BE DONE FOR PROCESSING.

CONFIDENTIALITY STATEMENT: UTHealth Houston requires you to provide personal health information protected by University policy and State and Federal law. Your information will be used or disclosed in accordance with those policies and laws only to the minimal extent necessary for your treatment or for business operations. Your rights to the confidentiality of your personal health information will be strictly maintained by UTHealth.