Accident or Injury Report

State or Research Foundation (RF) employees complete, sign and submit this report about on-the-job accidents or injuries. After submission Human Resources will send you a New York state packet of Workers' Compensation forms to complete.

Read About the Workers' Compensation Procedures for All Employees

Instructions

  1. Complete the form online or download a blank form to fill in by hand
  2. Keep a copy of the hand-filled form; the online form will provide you a PDF copy on your desktop AND in email
  3. Sign the form
  4. Submit the form to:

Human Resources
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

Choose Which Form To Complete

Download a Blank Copy of Accident or Injury Report

        or complete this online form:

Need Help Completing the Form?

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UB HR Leaves

State Benefit Services

Phone: 716-645-7777

Email: ub-hr-leaves@buffalo.edu

Form Facts

Form Type: Formstack/Webmerge (or PDF)

Requirements: Adobe Reader
 

Updated: 7/2015

Owner: Benefits, Human Resources