Université d'Ottawa - University of Ottawa - Canada's university

Formulaire d'accident, d'incident ou de maladie professionnelle / Accident, Incident or Occupational Disease Form

This form must be completed and submitted before it can be saved in a pdf format. Please note that yellow boxes are required fields. Should you need assistance in completing the form, consult the guidelines for completing an accident, incident or occupational disease form or contact the Employee Health, Wellness and Leave Sector in Human Resources Service at extension 1473. Report any technical problems with the webform to: incident@uottawa.ca. This form requires scripts to be enabled on your browser. A non-scripts version of the form is accessible here. If your browser reports errors when using this form try the non-scripts version. Which of the following Occured? An Injury or Exposure Occupational Disease, Potential or Actual Actual or Potential Health Concern Incident Only/No Injury None of the Above   To Whom did it Occur? -- Select -- Employee Student Student working for the University of Ottawa Person on a Work / Education Placement Contractor / Sub-Contractor Visitor Other To Whom does this Person report? -- Select -- Immediate Supervisor Acting Supervisor Not Applicable Other, specify   Error