City of Saint John Online Incident Reporting Form

Please note this form is for both internal and external reporting. Please select "external submission" if the incident is not a result of a workplace incident.

IN THE EVENT OF A SERIOUS WORKPLACE ACCIDENT PLEASE CALL THE FOLLOWING:

1. WorkSafeNB: 1-800-999-9775
2. Immediate Manager
3. Safety Manager: Corey Curnew 506-721-1531
SUBMISSION DETAILS






EMPLOYEE DETAILS








Ex) MM/DD/YEAR 12:00AM




firstname.lastname@saintjohn.ca


firstname.lastname@saintjohn.ca


firstname.lastname@saintjohn.ca



INCIDENT DETAILS



HH

MM

AM/PM



















(*Form 6 and 7 required)

CLAIMANT DETAILS (PERSON AFFECTED)











CLAIMANT INSURANCE DETAILS (IF AVAILABLE)







WITNESS INFORMATION





ADDITIONAL DETAILS / COMMENTS

FILE UPLOADS
Please attach any photos or other pertinent files here. File Max: 1MB. Please resize larger images prior to upload.



Thank you for your submission. Due to the high volume of inquiries it may take up to 7-10 business days for a response. If you are not contacted within this timeframe, please contact Sabrina at Sabrina.Nason@saintjohn.ca.