Report an Incident or Injury

Report an Incident or Injury

 
Complete this form to report an incident or injury to PICS Human Resources. You also have the option to report to PICS Human Resources by phone at 651.967.5060. Please allow 48 hours for processing.
 
Please note: All incidents or injuries must be reported within 24 hours of when the program became aware of the situation. A separate report must be completed for each person. Do not use identifying information such as names or initials if the incident or injury involved the person receiving services. PICS Human Resources will contact you for further information.

Address
People Involved with Incident or Injury (Select All That Apply)
Type of Incident or Injury (Select All That Apply)
Contact

PICS Human Resources

651.967.5060