Incident/Liability Claim Reporting

Use this form to report all incidents that resulted in an injury or property damage or had the potential to cause an injury to others on University property or at a University activity or event. (For auto accidents involving University vehicles or occurred while traveling on behalf of the University use the Auto Accident Report Form.)


DO NOT USE THIS FORM FOR EMPLOYEE INJURY REPORTING

Employees, including student workers, must report workplace injuries via the Workplace Injury Reporting Form (Workers Compensation).


If an incident resulted in a medical emergency (visit to the emergency room or medical transport) or caused more than $25,000 in property damage contact the Office of Compliance and Risk Management at 662-325-6820.


Do not wait to complete this form. Report as much information that is available to you as soon as possible, additional information may be provided at a later time.

 

Incident Information

 
 
 
 
mm/dd/yyyy
 

Briefly describe what happened and who was involved. Attach additional information such as photos or official reports at the bottom of this form under "File Upload."

 
 

Specify the location where the incident occurred, including any relevant building or area names.

 
 
 
 

Attach, all referenced reports or other supporting documentation. i.e. Police Reports, Incident Reports, Photos, Receipts, Bills, Quotes, Estimates, Invoices.

Drop your files here