Report an Injury, Safety Concern, Near-Miss, or COVID-19 Safety Concern

Injuries, safety concerns and/or COVID-19 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.

Please complete the following and click CONTINUE.
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:

       Injury/illness - resulted from an incident.
       Safety Concern - unsafe condition or unsafe behavior.
       Near Miss - event that could have resulted in an injury/illness or caused property damage.

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

       UC Irvine CAMPUS Employee (including SOM employees working at UCIMC)
       UC Irvine MEDICAL CENTER Employee
       Student Employee
       UC Irvine Student Only (Not an employee)
       Other

3. Was a vehicle involved?

Yes No

4. If a vehicle was involved, was it? (choose one):

        University vehicle
        Non-university vehicle being used on University business
        Other

Resources

CAMPUS: Human Resources: Insurance & Risk Management

MEDICAL CENTER: Workers' Compensation