Environmental Health & Safety
Supporting the campus community by proactively protecting people, property and the environment in a responsible and cost effective manner.

Report an Injury, Safety Concern or Near-Missed

Section 1

Report an Injury, Safety Concern or Near-Miss

Injuries, safety concerns or near-misses occurring on campus or while participating in University business should be reported within 24 hours. For non-vehicle property damage ONLY, please see HOW TO: Report Damaged or Destroyed Property.

If you or your employee experiences a serious injury that requires a trip to the hospital, please contact EH&S immediately at (949) 824-6200.    - During business hours, press 1 to be connected to the front desk.
   - After hours and on weekends, press 2 to be connected to an EH&S responder.

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 nature of the incident:

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


3. Was a vehicle involved?   


CAMPUS: Human ResourcesInsurance & Risk Management

MEDICAL CENTER: Workers' Compensation