LSU Office of Risk Management | 124 Public Safety Building, S. Stadium Dr., Baton Rouge, LA.
email: email@example.com | phone: (225) 578-3297 | fax: (225) 578-3577
When an injury occurs, the first priority is taking care of immediate medical needs. For emergencies call LSU Police: 225-578-3231
Use this form to report all incidents that resulted in an injury or had the potential to cause an injury to an LSU employee or injury to others on University property or at a University activity or event. (For auto accidents use the Auto Accident Report form.)
Employees (Faculty, Staff, Graduate Assistants, Student Workers)
This form is only required if the injured employee is unable or unwilling to call the Emergency Injury Call Center. When a work injury or illness occurs, the employee should notify their supervisor and then call the Employee Injury Call Center at 877-764-3574 to speak to a registered nurse. The Call Center is available 24 hours every day. The nurse will discuss the incident/injury with the employee and determine the employee’s immediate medical needs. If the employee does not contact the call center, then the supervisor, or someone else from the department, should complete this form.
Non-Employees (Students, Visitors, Vendors/Contractors)
This form should be completed by the LSU department that experienced or has been made aware of an incident that resulted in, or may have resulted in, an injury to a non-employee. LSU Safety, Risk Management or its adjuster will respond to the report as needed.
Submit this form immediately. Entries with an asterisk * must be completed in order to submit the form. When finished, click the “submit” button (or email/ fax the completed form to LSU Risk Management).
THIS FORM MUST BE SUBMITTED IMMEDIATELY