Stanford University

Incident Report (eSU-17)

Stanford is committed to keeping a safe environment for their employees, students and visitors.

Incidents involving injury/illness or close-call events must be reported here within 24 hours of occurrence.  This reporting helps identify possible hazards and opportunities to improve our future safety.

IMPORTANT! Any injury resulting in death, permanent disfigurement, dismemberment or hospitalization expected to last more than 24 hours shall be reported immediately to EH&S at 650-725-9999.

Report an Incident (Injury, Illness, or Close Call Event)

 

Instructions for Supervisors
    1. After an incident occurs, it is to be reported by the employee or on behalf of the employee.
      • You may submit the initial Incident Report on behalf of your employee by clicking the Submit an Incident Report button at the top of this page.
    2. Once a report is submitted, the supervisor will receive an email with a direct link to complete the Supervisor Followup section.
      • Tips to assist Supervisors in conducting an investigation into an incident are available here. For additional assistance contact EH&S at 650-723-0448.
    3. Upon submittal of the Supervisor Follow-up report, the supervisor will receive an email containing information from Incident Report and the Supervisor Follow-up report. This can be forwarded to the local HR Manager or others in your department per your local policy. Users can also download a PDF of the form while completing the report.
    4. As corrective action(s) are identified to prevent similar recurrence, the Supervisor is responsible for promptly implementing them, and documenting their completion.

Information for HR Managers
    • The on-line eSU-17 Incident Report form replaces the previous paper SU-17 form. Using the eSU-17 eliminates the need to fax or email forms to Risk Management.
    • Employees are encouraged to report incidents directly but supervisors may complete the form on behalf of their direct reports.
    • There are other forms that may need to be filed including Employees Claim for Worker Compensation Benefits (DWC-1) and Workers Compensation Lost Time Report (SU-16). See the Admin Guide for details on reporting requirements.
    • Employees and supervisors will receive emails that confirm submittal of the eSu-17 Incident Report and completion of the Supervisor Follow-up section.
      • These emails will contain copies of the Incident Report and Supervisor Follow-up report. HR Managers can request employees and supervisors to forward or print a copy of the submitted forms.
      • A PDF copy of the form can be downloaded upon completion of the Initial Incident report and Supervisor Follow-up reports.

FAQs

When to report:  Any incident (illness/injury or close call) that occurs on campus to a University employee, student, visitor, or contractor must be reported promptly, but no later than 24 hours afterwards.

  • Incidents that occur at the National Accelerator Laboratory (SLAC) must be reported to the SLAC Medical Department.

For anonymous reporting (not for injuries), contact the Ethics and Compliance Helpline.

Who can report:

  • Employees or their supervisor.
  • Non-employees (i.e., students, visitors, contractors) or an associated Stanford representative.

Where does this report go? The Incident Report is sent to the responsible University supervisor/manager, Environmental Health and Safety (EH&S), and Risk Management to take any necessary corrective measures towards addressing associated safety issue(s). Individuals listed in the employee and supervisor email fields automatically receive a copy of the submitted information. Additionally, the reporting party can download the report after submission.

The reported information is kept confidential and only shared with those University units managing the relevant safety risks and regulatory compliance.

What happens next? The responsible supervisor is prompted to complete incident follow-up/analysis to take necessary corrective measures towards addressing any associated safety issue(s). When the supervisor completes their follow-up report, the employee will receive an email containing the information from the follow-up report. EH&S may follow up with the person(s) involved and their supervisor to gather additional information and support local safety improvement.

Need assistance completing the on-line eSU-17? E-mail us at esu17support@lists.stanford.edu.

Back to Top