Form Instructions and Important Notes

NOTE: Serious injury, or fatality must be immediately reported, call 320-308-3333 / 911.

Instructions:

  1. Use this form for all incidents (student or visitor injury).
  2. Complete as much information as possible and submit within 24 hours.

Insured Entity: St. Cloud State University
Email Address: SafetyAdmin@stcloudstate.edu
Contacts: Alyssa Johnson & Kevin Hammond

Please fill in the following information. 

Incident Information
Injuries
Person Completing Form