Alfred University
Accident/ Incident/ Near-miss Investigation Report
Please submit this form and all documentation to and notify EHS within 24 hours. Please print clearly and legibly or use a computer to fill out form – See last page for instructions.
Notes:
- Attach/include any and all supplemental communications or documentation.
- For major emergencies or accidents, notification must be made regardless of time or day (includes after normal hours, weekends, and holidays) to Public Safety 607-871-2108.
- If an injury requires in-patient hospitalization or results in death, Public Safety or the supervisor must immediately contact EH&S.
Retaliation Policy: Alfred University strictly prohibits any form of retaliation against an employee who reports workrelated injuries and illnesses, makes a complaint, raises a concern, provides information or otherwise assists in an investigation or proceeding regarding any conduct that he or she reasonably believes to be in violation of Alfred University’s safety rules or policies, or applicable laws, rules or regulations. This policy is designed to ensure that all employees feel comfortable reporting work-related injuries or illnesses without fear of retaliation. It is also intended to encourage all employees to cooperate with Alfred University in the internal investigation of any matter by providing honest, truthful and complete information without fear of retaliation.
Fax immediately to EHS at 607-871-2086 Or email: envhealthsafety@alfred.edu