INCIDENT FORM

Table of Contents:

• Purpose
• General Information
• Exhibit and Instructions
• Form Requirements
  • Accessing GURU Forms:
    • Web-based Documents:
    • Converting Web-based Documents to PDF Documents:
  • Exceptions:
    • Combining PDF Documents:
  • Applying Digital IDs on PDFs (general instructions):
  • Clearing Fill-and-Print Form Field Entries
• Number of Copies and Ultimate Distribution
• Where To Send Completed Forms
• Contact Information
• Cross References

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Purpose:

The Incident form provides a means for the Claims Manager within the Office of Risk Management to obtain factual information to evaluate claims for property damage or bodily injury accidents or incidents.

General Information:

DO NOT use this form for worker's compensation claims (see Human Resources Workers' Compensation website) or for automobile accident/injuries claims (see Vehicle Accident Report). Each of those website contains documentation related to those types of events.

Complete the form, in its entirety, and describe the incident in detail. The individual intending to file the incident form must sign and date the completed form. If the individual is unable to complete the form, a University representative may assist with completion of the form, but the form must be signed by the individual.

The completed and signed form is to be turned into the College/Departmental Safety Officer or Commonwealth Campus Director of Finance & Business, who will file the report with the University's Office of Risk Management.

Exhibit and Instructions:

For step-by-step instructions for completing the Incident Form, click the link below:

Incident Form Exhibit

Form Requirements:

No form may be used that substitutes for an approved official University form without prior review and approval by the steward of the form/central office, as facilitated by the Office of Systems and Procedures (designated representative of the Corporate Controller). Policy FN17 Required Use of Approved University Forms Appearing in the General University Reference Utility (GURU) requires that all form templates must be vetted and approved prior to being published on the GURU website and all such documents having gone through said established approval process must be password protected.

Accessing GURU Forms:

GURU PDF forms are designed for use with Adobe Acrobat Reader or Adobe Acrobat Pro. Each browser (Chrome, Firefox, Internet Explorer, Microsoft Edge, etc) has a built-in PDF viewer making it the default PDF viewer without asking users. These built-in viewers do not necessarily support all features required for PDF forms. Similarly, many calculations are not supported by other stand-alone PDF readers (for examples, Nuance). It has been brought to the attention of the Office of Systems and Procedures that PDF forms do not function appropriately when accessed using Firefox and/or Microsoft Edge. In order to access any of the forms on GURU and have the fill-and-print functionality work properly, the end-user must access the GURU website using Google Chrome.

The latest version of Adobe Acrobat Reader is available for free. Contact your IT support staff person for downloading assistance, if/as needed. If Adobe Acrobat Pro better suits your needs, contact your IT support staff person for purchasing and installation assistance.

Web-based Documents:

Clicking the form download icon on any of the form instruction pages on GURU will open a web-based version of the form. While it appears to have fill-and-print fields available, not all functionality may be available for use (i.e. digital ID fields). With some exceptions (see below), it will be necessary to convert these web-based documents to PDF documents.

Converting Web-based Documents to PDF Documents:

There are two (2) options available to download forms:

Option 1 - To create a PDF for this document:

• Click the download icon located in the upper right-hand corner of the web-page
• Select a location to save the document where you will be able to locate the document
• Click Save
• Open the document from the saved location

Option 2 - To change system settings to always open documents with Adobe:

• Click the download icon located in the upper right-hand corner of the web-page
• Select a location to save the document where you will be able to locate the document
• Click Save
• The file will appear in the bottom left-hand corner of your browser window. Click the small up arrow to the right of the file name
• Click the "Always open with system viewer" option
• The form now opens as a PDF and can be completed
• All PDF files will now open in a separate window in Adobe

Exceptions:

Combining PDF Documents:

There may be times when it is necessary to combine multiple PDF documents into a single document for submission. In those instances, complete the following steps:

• Click on the appropriate form in GURU
• Complete the fill-and-print boxes on the web-based form (do not complete the digital ID process at this stage)
• Click the print icon located in the upper right-hand corner of the screen
• Change Destination to Microsoft Print to PDF using the drop-down arrow
• Click Print at the bottom of that panel
• Enter a file name in the box at the bottom of the pop-up window and be sure to select a location where you will be able to relocate the document
• Click Save

Repeat this process for each document that will be combined (each file name must be different from the previous)

• Now, open one of the completed PDF documents and on the far right select combine files
• Click Add Files and select the files to be combined
• Click Combine
• The new document will have the title "Binder" - change the file name and save
• Open the new document, apply digital ID signature (if appropriate), and save again

Applying Digital ID's on PDF's (general instructions):

This form has the Digital ID (applying an electronic signature to the document) process enabled. Complete all fill-and-print form fields before completing the signature process:

1. Open the Incident Form
2. Complete all fill-and-print fields
3. Once the form is complete, click in the signature form field and either:
   • select your digital ID and click continue, or
   • create your digital ID, select your digital ID, and click continue
4. Review the information in the appearance box and click sign
5. You will be required to save a copy of the document (the digital signature is not applied until the form is saved)
   • A pop-up window opens with the file name containing incident-form in the File name field. Add the last name, a dash, and first name of the individual involved in the incident (i.e., incident-form-smith-mary)
   • Select a location where you will be able to retrieve the document
   • Click Save
6. Close the form version appearing on your screen
7. Open the version saved in the previous steps
8. Verify that the digital ID appears on the document
9. Close the document

This form has the "Clear Form" Bookmark enabled. To clear ALL form field entries:

• If left-hand column is not displayed when the document is opened, click the small arrow located at about the mid-point of the left-hand side of the screen to reveal the column
• Click "Bookmarks" (looks like a ribbon)
• Click "Clear Form"

If you encounter any difficulties, contact the GURU support staff by submitting a Technical Support Form request.

Number of Copies and Ultimate Distribution:

Where to Send Completed Forms:

Forward to Claims Supervisor, Office of Risk Management.

Contact Information:

For questions, additional detail, or to request changes to this form, contact the Office of Risk Management.

Cross References:

• Policy AD35 University Archives and Records Management
• Policy FN17 Required Use of Approved University Forms Appearing in the General University Reference Utility

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(2022Mar22)