Do not use this form to report and injury or illness. To report an injury or illness go to the Report an Injury page.
If you have a safety question or concern, encounter a non-life threatening hazard, or see a hazardous event or condition complete this form or report anonymously to EH&S at (949) 824-6200.
When did the dangerous event or hazardous condition occur?
Describe the location of unsafe condition or hazard:
(e.g., Bldg/Rm or Parking Lot, Interior/Exterior, nearby landmark )
Did the incident occur in a lab or was the incident related to research activities?
Describe the unsafe condition, event or hazard (e.g., chemical, biological, etc):
What do you think was the cause of the unsafe condition or hazard?:
What actions would you recommend to correct or prevent the unsafe condition, event or hazard?
Indicate other parties this unsafe condition or hazard been reported to, if any:
A UC Irvine school or department administrator, manager,
The UC Irvine Environmental Health & Safety Office
The UC Irvine Police Department
If you would like to be contacted regarding this information, please provide your name and email address:
It is illegal for any California employer to take action against employees who exercise their right under the law to report perceived
or actual unsafe and/or unhealthy conditions or hazards to their employer. Reprisal to employees for exercising their right for safety and healthy
related activities will not be tolerated.