Accident and Incident Reporting at Tufts University
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.
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.
The report should be emailed to Debopom Mitra, Risk Management – Tufts University (Debopom.Mitra@tufts.edu) or sent to: Debopom Mitra– Tufts University, 169 Holland St, Somerville, MA 02144.
If an employee is out three (3) or more work days, please contact Human Resources at email@example.com.
For information on the Workers’ Compensation Program, please go to the Risk Management & Insurance website under the Finance Division.