ENHS | Accident & Near Miss Form Final

Page 1 of 3 . You are 34% complete.

Form Selection

If you believe there is an immediate danger to life or health call 911 or University Police at (479) 575-2222.  For emergency information, threats of violence, sexual misconduct, and other procedures visit safety.uark.edu.

This form is intended to inform the Environmental Health and Safety Office (ENHS) of accidents, injuries and unsafe conditions on campus. This form is in reference to VCFA Policy 700.2. 

PLEASE NOTE:  Any event involving workplace injuries must be reported directly to Risk Management using the appropriate University form to be considered for workers' compensation claims. This accident form is not intended to take the place of workers' compensation claim forms.

Please be aware this form will time out after ten minutes of inactivity. 


Accident or Injury Reporting

Please report bodily injury or property damage so ENHS can capture a record of the incident and respond as appropriate.


Hazardous Condition or Near Miss Reporting

If you believe that an unsafe condition exists on campus, you have the right and are encouraged to make a report of the condition (e.g., sidewalk has become displaced, proper protective equipment not provided or available). Please do not wait for someone else to report a hazard.  Let ENHS know right away so it can be addressed before someone is injured. 

Please choose your form. Required