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

NOTE: If you are an employee of UCI Health, at any UCI Health site, you should make your report through the UCI Health Safety and Quality Information System (SQIS). Go here, and LOG INTO SQIS.

If you are a School of Medicine (SOM) employee working at any UCI Health location, please use this portal (campus) to report all injury/illnesses and near-misses.

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 EHS 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 EHS 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: Risk Services

MEDICAL CENTER: Workers' Compensation