Incident Report Form 
To reach a City of Omaha Safety Inspector, please contact us at the following numbers:

Bud Post 402-983-7597
Jake Behrns 402-982-5779
Josh Fisher 402-979-1215
Chad Ijames 402-995-1628
Shane Lett 402-378-3964
Shawn Smith 402-830-7017

By submitting this form - this will constitute the required notification to City Safety. 

You are still responsible for submitting all required accompanying forms, photos, and other documentation to: HRSafety@cityofomaha.org

Workers' Compensation forms and documentation must be sent to: workerscomp@cityofomaha.org

Forms may be found at: https://hr.cityofomaha.org/safety

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Email *
Your Name & Phone Number *
Supervisor Name & Phone Number *
If same as above, enter "same"
Division/Department *
Notify your next level Supervisor *
Name(s) or Employee(s) involved in or witness to incident *
Describe/summarize incident *
Location of incident *
Be specific: Include address, etc.
Time of incident *
Time
:
Type *
911 must be called in the event that immediate medical attention is required.

Was 911 called?
 *
Was an employee taken to a medical facility? If so, please state their name and location of where they were transported. *
If not, enter "No"
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