Incident Report • CampusOptics

This form should be used to report physical safety hazards and may include concerns relating to fall protection, ladders, confined space, PPE or job related hazards.

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Basic Information

Department

Affiliation

Occurred At

Concern Description

Describe the nature of the safety concern in detail, including any hazardous conditions or equipment involved.

What is the specific location or job task where the safety concern occurred?

Were appropriate safety measures, equipment, and signage in place at the time of the concern?

Were employees adequately trained and informed about the relevant safety procedures and equipment?

Were there any injuries or near misses associated with the safety concern?

Add Supporting Documents

Add files to upload as supporting documentation along with your incident report.