Loading...
Your form has been saved, but you still need to fill in the following fields. Please return to the form and use the highlighted tabs above to see which pages have missing information:
What happened before and during the incident. When and where the incident occurred.
Want to finish this form later? Use this link: https://uw.safety.uwaterloo.ca/public_incident?incident_code=zl525hn071a17w1u6lmbjx87
(maximum 30 MB per file, JPEG, GIF, PNG, PDF, DOC, DOCx, VIDEO, AUDIO ONLY)
Collection Notice:
The information on this form is collected under the authority of the Freedom of Information and Protection of Privacy Act (R.S.B.C. 1996, c. 165). It is related directly to and needed by University of Waterloo in order to follow up on health and safety reports and to comply with The Workplace Safety and Insurance Board of Ontario requirements. The information will be used to contact individuals who made or are referenced in the report, to notify key UW employees and departments of the incident when required, and to initiate an incident investigation when required by The Workplace Safety and Insurance Board of Ontario. It may also be used to facilitate the administration of a The Workplace Safety and Insurance Board of Ontario claim. If you have any questions about the collection and use of this information please contact Andrew Scheifele, 200 University Ave W, Waterloo, ON, N2L3G1, safety@uwaterloo.ca.
Here you can enter all of the people who were involved in the incident.
Click the "Add Person" button below to add people to this incident.
NOTE: Because this incident has been indicated as "Workplace Harassment", the people entered into the below involved people record list will NOT be able to view this incident or receive notifications about it. In the below record list, please only enter the victims of the harassment, witnesses, or supervisors (if necessary). Do not enter the aggressors in this record list, they can be added on the previous tab.
Add Person
Enter any property damage or environmental impact that occurred as part of the incident.
Add Property Damage
Add Environmental Impact
Once all of the required fields are completed, you can submit your form.
When you submit your form, notifications will be sent to the appropriate people for follow-up of the incident.
Your form has been automatically saved
Thank you for your submission. If necessary, we may contact you for more information.
You may close this browser window.
