Student Injury/Illness Report Form

Use this form to report an injury or illness involving a student. Please complete and submit within 24 hours. 

This form will ONLY accept email addresses. If you input a different email address, it will cause an error and your form will not submit.

  • ONLY email addresses will work.
  • Listing the employee email will allow them to receive a copy of this report. ONLY email addresses will work. Inputting of a email address will cause the form to not submit.
  • MM slash DD slash YYYY
  • :
  • :
  • i.e. Building and room
  • Witness

  • Second Witness

  • Third Witness