Environmental Health & Safety

Report an Incident or Safety Concern

Section 1

Report a Safety Concern or Near Miss

To report an injury or illness go to the Report an Injury page.

Use this form to report a safety concern, e.g. a non-life threatening hazard, or hazardous event or condition. This information can also be submitted by calling EH&S at (949) 824-6200.

When did the dangerous event or hazardous condition occur?

Date/Time:   Pick a date


Did the incident occur in a lab or was the incident related to research activities?

 YES    NO


Provide the location of unsafe condition or hazard:
(e.g., Bldg/Rm or Parking Lot, Interior/Exterior, nearby landmark )


Describe the unsafe condition, event or hazard (e.g., chemical, biological, etc):


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




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.