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.


  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

        or complete this online form:

Need Help Completing the Form?


UB HR Leaves

State Benefit Services

Phone: 716-645-7777


Form Facts

Form Type: Formstack/Webmerge (or PDF)

Requirements: Adobe Reader

Updated: 7/2015

Owner: Benefits, Human Resources