Click here to take survey

Department of Public Safety

San Juan College
Department of Public Safety
Statement Form

If you were involved in a vehicle accident with injuries or involving SJC property, complete the following:

I attest that the statement I have given is true and accurate and I have given this statement of my own free will and accord and have not done so as a result of threat or promise. If this is correct, please input your first and last name in the signature box below.

* Denotes a required field.

If you have suffered a work-related injury or illness,
contact the Department of Public Safety
at 566-3333 immediately.