Button color and preset tabs/native tab order was set based on the computer's identity, not the user's. The settings may not reflect what you want - but you can change them.
Button color and preset tabs/native tab order were set to default values. The settings may not reflect what you want - but you can change them.
Please locate the field indicated by red and correct.

Office of Insurance, Loss Control & Claims

Incident Reporting Form

Use this form for injuries to students, visitors and guests of all Indiana University affiliated campuses, vehicle accidents and for reports of damage to university property. For employee occupational injuries or illness, go to the IU Occupational Injury Illness page.

In the event of an incident involving serious injury, please call someone for an immediate response.
Date and time of incident:





(if known)