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Office of General Counsel
Room 224
Perlstein Hall
10 West 33rd Street
Chicago, Illinois 60616
(312) 567-3034
(312) 567-3004 (fax)
Please complete the following Incident Investigation form if the accident concerned a subject covered by IIT's
Safety Policies and Procedures.
If you prefer, you may print and submit a hard copy of this
form
to (1) the head of the affected department, (2) the co-chairs of the safety committee and (3) the University Laboratory Safety Coordinator or Director of Environmental and Occupational Safety, as appropriate.
I. Incident Information
Date of Accident:
January
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Day of Week:
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Department / Location:
© 2006
Illinois Institute of Technology 3300 South Federal Street, Chicago, IL 60616-3793 Tel 312.567.3000
