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Thompson Rivers University
Thompson Rivers University

TRU Employee Incident Report Form

Worker’s Report of Injury or Occupational Disease to Employer

If you are an EMPLOYEE of TRU and experience an INJURY or INCIDENT, then please fill this form.

The WorkSafeBC form can also be downloaded and sent to TRU’s Safety department - Worker’s Report of Injury or Occupational Disease to Employer Form 6a.

If you need assistance filling out this form, then please contact [email protected].

TRU Employee Incident Report

Personal information













Period of exposure resulting in occupational disease



hh:mm


Who did you report to and when?



hh:mm


First Aid



hh:mm


Physician or Provider




hh:mm




Witnesses


Type of incident


What part of the body was injured?


ex: room number, parking lot, outside

Lifting






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