NC Department of Insurance Banner with NC Department of Insurance Logo, State Seal and Photos of typical insurance consumers

Injury Prevention

Report A Save

In an effort to document and record SAVES in North Carolina, we are asking you to submit information about any SAVE that takes place or has taken place in your community. By SAVE, we are referring to an event where someone was not injured or killed due to the positive impact of your injury prevention program. This information will be used to illustrate the success of injury prevention programs and to use as a tool to encourage more Chiefs, Directors, Supervisors, etc. to become involved in effective injury prevention programs. Please take a few minutes to complete the form below.


Incident Information


(Please write a brief summary of the incident details, telling us exactly what happened leading up to and during the event. Provide as much detail as you can including person’s involved, Educators involved, Chief/Directors involved and any other important information that may be useful.)
Form Submitted By
Chief/Director Information
Supporting Informaion

Please submit any newspaper articles or pictures of the event, safety device, child, fire department, agency, etc that is public information to or Print and mail completed form, pictures, articles, etc. to:

Shannon Bullock
1202 Mail Service Center
Raleigh, NC 27699-1202


Please contact if you need help with this form.