Small Claims Incident Report

Members of the UB community can file a small claims incident report arising from alleged negligence on the part of the University at New York. This "small claim" cannot recover damages in excess of $5,000.00 and does not include damages because of the actions of students, independent contractors or consultants.

- Claims must be filed within ninety (90) days of the alleged incident.

- The university does not reimburse for costs related to vehicle rental. The claimant must submit these charges to the personal insurance carrier.


  1. Complete the Incident Report
    1.  Include additional supporting documentation (e.g., police reports, photographs, charts, maps, diagrams) 
    2. Write your full name, incident date, item description and location of incident on reverse side of attachments
    3. Include a minimum of 2 estimates for vehicle damages
    4. Clearly explain the incident and why you believe the university is responsible
  2. Send it immediately to: 

        EH&S Small Claims Administrator
        220 Winspear Avenue
        Buffalo, NY 14215

or fax to: 716-829-2704

Download the Form

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

Enviornment, Health & Safety
220 Winpsear Ave
South Campus

Need Help Completing the Form?

Send email, phone or submit a question

Environment Health & Safety

Service Building, 220 Winspear Ave.

Phone: 716-829-3301


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Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Owner: Environment, Health & Safety