Policy and Procedure
Accident/Incident Report Form
The Accident/Incident Report Form should be used by all faculty members, staff members, students, contractors and visitors to report any accident that resulted in bodily injury/illness, an incident that could have resulted in bodily injury (a near miss) or an incident that resulted in property damage that occurred on Tufts property or on a Tufts sponsored/approved activity off campus.
Note: Motor vehicle accidents (while driving on behalf of the university, on or off campus) must also be reported directly to Tufts Police at 617-627-3030. Visit http://publicsafety.tufts.edu/adminsvc/tufts-university-fleet-policy/ for more information.
PLEASE COMPLETE THIS DOCUMENT TO THE BEST OF YOUR ABILITY. LEAVE ANY QUESTIONS BLANK THAT YOU DO NOT KNOW THE ANSWER TO OR WHEN INFORMATION IS NOT READILY AVAILABLE. IT IS MORE IMPORTANT THAT TUFTS BE ADVISED OF THE INCIDENT AS SOON AS POSSIBLE, RATHER THAN RECEIVE A COMPLETED FORM. IN THE EVENT OF A FATALITY, INPATIENT HOSPITALIZATION, AMPUTATION OR LOSS OF AN EYE, IMMEDIATELY CONTACT TUFTS UNIVERSITY POLICE AT 617-636-6911.
Link to Form: Tufts University Accident Incident Report Form
The report should be emailed to Bret Murray, Risk Management – Tufts University (Bret.Murray@tufts.edu) or sent to: Bret Murray – Tufts University, 169 Holland St, Somerville, MA 02144.
If an employee is out more than five work days then a Personnel Action Form (PAF) must also be completed and submitted to the Human Resources Service Center. Complete the form as a Paid Leave for Worker’s Compensation. Click here to download
For information on the Workers’ Compensation Program, please go to the Risk Management & Insurance website under the Finance Division.