Incident Report Triage!

Environmental Health & Safety : Human Resources : Insurance & Risk Management

Incident Report
Report an Injury, Incident or Safety Concern

Accidents, injuries, safety related incidents or concerns on campus or while participating in University business, should be reported within 24 hours.

For Property Damage ONLY (not vehicle) - Please see HOW TO: Report Damaged or Destroyed Property.

Instructions: Please complete the following and click CONTINUE to report an incident.
If more than one person was injured, please submit a report for each person.

1. Select the information that best describes the incident:

Injury/illness or possible injury/illness resulted from incident.
Dangerous event or unsafe condition.

2. What is the affiliation of the person for whom this form is being completed?

   UCI Employee
   Student Employee
   UCI Student Only (Not an employee)
   Other

3. Was a vehicle involved?
Yes No