Injury or Illness Report
 

    Instructions

    INSTRUCTIONS: This report should be submitted by individuals who have injuries on the UA campus. Also, employees who have an injury or illness that may be covered under the UA On-the-Job Injury and Illness Policy should complete this form.

    Report Injury or Incident

    Expected format: mm/dd/yyyy HH:MIPM
    Expected format: HH:MI PM
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