Use this form to report a safety or COVID-19 concern, non-life-threatening hazard, or hazardous event or condition. This information can also be submitted by calling EHS at 949-824-6200.
To report an injury or illness go to the Report an Injury page.
When did the dangerous event or hazardous condition occur?
Date/Time:
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., building/room, 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)
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.