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  (920) 424-3215
  214 Dempsey Hall


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Useful Forms

General Incident Report (DOA-6441) 

The General Incident Form is used for any accident that occurs on campus. Risk and Safety encourages the reporting of all incidents, especially if there have been injuries or property damage. Please complete the following form and submit it to the Risk and Safety Office (Dempsey Hall, Room 214).

Vehicle Accident/Incident Report (DOA-6496) 

This form is required if you have been in an accident with a State Vehicle. This form must be submitted to the Risk and Safety Office (Dempsey Hall, Room 214) within 24 hours of the accident. Report the accident to law enforcement immediately following the incident; as well as inform the UWO Facilities Management Main Office ( as soon as possible.

Uniform Affiliation Agreement

This form must be used for any field placement or internship where students will be working with an outside agency which agrees to participate in a cooperative effort with the University. This form should be signed by the outside agency before submission to Risk and Safety in Dempsey 214 for review and approval.

Program Memorandum

Memorandum of Understanding between The Board of Regents of the University of Wisconsin System (on Behalf of UW Oshkosh) and UW Oshkosh Departments to set forth the terms and understanding.

Report a Safety Concern

Use this form to report safety concerns, near misses, or minor incidents.

Caregiver Addendum

This form is required for all health care field placements or internships. This completed addendum must be attached to the above listed Uniform Affiliation Agreement.

Field Trip/Activity Waiver

This waiver should be completed before participation in field trips or other activities; releasing the University of any risks that may result due to participation.

Facility Use Form

This form should be completed by any organization who is using University facilities for non-University sponsored activities and/or programs.

Volunteer Forms  

See the HR website for the appropriate forms to complete for volunteer services entered into by and between a volunteer agency and UW Oshkosh. The specific responsibilities to which both the volunteer agency and UW Oshkosh agree to are specified in these forms.

Notice of Claim Form

This form should be completed when an individual is claiming damages, injuries, or death resulting from an encounter which occurred due to the negligence of a state officer, employee or agent or on state property. This form must be served by certified mail within 120 calendar days of the event. This form must also be notarized by a Public Notary of the State of Wisconsin.