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Report of Injury / Illness / Hazard
Call 803-648-4011 in an Emergency
Your Name
Prefix (optional)
First Name
Middle Name (optional)
Last Name
Phone
Email Address
Affiliation with the university
faculty
staff
student
Information Requested
Category of Incident
Injury
Illness
Hazard
Date/Time of Incident
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Month
Jan
Feb
Mar
Apr
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Jul
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Day
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Year
2019
2020
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2027
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2029
Hour
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Minute
:
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59
AM/PM
AM
PM
Description of Incident
Actions / Treatment Taken
USC Aiken Staff Notified
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