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

Report an Incident or Safety Concern

Section 1

Report a Safety Concern or Near-Miss

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?

Date/Time:   Pick a date

 

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?

 YES    NO

 

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, or supervisor

  The UC Irvine Environmental Health & Safety Office

  The UC Irvine Police Department

  Other:  

 

If you would like to be contacted regarding this information, please provide your name and email address:  

Name:   

Email:   

 

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.