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REPORT IT!
Accident, Injury, Illness,
Property Damage/Loss, Theft, etc.


If the incident threatens the health and/or safety of an individual or the College community or emergency medical care is necessary, call 911 IMMEDIATELY.

The REPORT IT! form is to be used to report employee, student and visitor ACCIDENTS, INJURIES, ILLNESS, PROPERTY DAMAGE or LOSS, THEFT, etc. This form replaces the First Report of Injury (work comp), Emergency Form/Non-Medical Report & the Medical Incident Report Form.

***This form is to be completed within 24 hours of the incident.***

If you have questions regarding the use of this report, please email Kelly McMahon, Executive Director for Risk Management at mcmahonke@nicc.edu

Reporter's Information

 
Email address must be of a valid format.
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Room number, parking lot description, address (off campus), etc.

Involved Parties & Witnesses

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list as much identifying information as available. ID number must be 7 characters in length, include the leading zeros if applicable.

Involved party 1

Questions

All questions require an answer. Enter NA if the question does not apply.

This field is required.
Was anyone injured?(Required)
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Was medical treatment necessary & what type? (Select all that apply)(Required)
You must make at least one selection.
This field is required.
This field is required.
Was there any property damage, loss or theft?(Required)
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This field is required.
Was this property personal or College owned?(Required)
This field is required.
Did you notify law enforcement?(Required)
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission