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Incident and Accident/Injury/Illness Forms and Instructions

  • Click here to access an Accident/Injury/Illness Report
  • Email the completed report to: security@dwd.in.gov
  • If the incident involves a facility issue, a copy of the incident report must also be emailed to:  dpalmer@dwd.in.gov (Dennis Palmer)
  • A copy of all incident reports involving a local office (only) must also be emailed to: FieldOperations@dwd.in.gov (Field Operations Coordinator)
  • Forward a copy of the completed report to your supervisor.


  • Any person claiming injury or property damage, either on DWD property or by a vehicle owned and operated by DWD, and who indicates a desire to be compensated for the loss, should obtain a copy of “Claim for Personal Injury or Property Damage” form to complete and mail as instructed. See DWD Policy 2011-03.


The aforementioned reports and forms must be completed wholly and to the best of the individuals’ knowledge. The summary must be specific, clear and concise. In order to preserve the integrity of the information available, the preparer should complete the form immediately upon becoming aware of the circumstances to be reported but no later than 24 hours after the incident occurs.


Contact the Investigations/Security Section of DWD at 317-234-3094.


Equal Opportunity is the Law. (La Igualdad De Oportunidad Es La Ley.)
Equal Opportunity Employer/Program Auxiliary aids and services are available upon request to individuals with disabilities.

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