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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:



 

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

      
      
      
      
      

 

3. Was a vehicle involved?   

            

 

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

      
      
      

 

Resources

CAMPUS: Human Resources: Insurance & Risk Management

MEDICAL CENTER: Workers' Compensation