Sonoran University of Health Sciences

ACCIDENT AND INCIDENT REPORTING FORM

Use this form to report accidents, injuries, medical situations, or student behavior incidents. If possible, the report should be completed within 24 hours of the event. Completed forms will be submitted to the Safety Officer, Dr. Kimberlee Blyden-Taylor who will forward the form to the applicable official(s):

Director of HR - employee related incidents
Dean of Students - student related incidents
Chief Medical Officer - patient related incidents
Facilities Manager - visitor related incidents

*In the case of an Injury (including needle stick): If the exposed individual is a Sonoran University employee, you are required to submit the Worker’s Report of Injury Form to ADOSH within 1 year of the exposure. https://www.azica.gov/forms/claims0407

* In the case of a needle stick or other puncture stick: you must also submit an Bloodborne Pathogen Exposure Report form: https://scnm.questionpro.com/a/TakeSurvey?tt=bKXFuGi%2BYyo%3D