Laboratory Incident Report

Please complete this form to describe any lab incidents, including injuries, spills, or near-misses. Click the submit button at the bottom to send the completed form to EH&S.

Your Name

PI's Name

Your Campus Email

Location: Building
Indicate the name of the building where the incident occurred.

Location: Room
Indicate the room number where the incident occurred.

Incident Details
Describe how the incident occurred to the best of your knowledge. Include as much detail as possible.

Follow Up
Check this box if you would like to have someone from EH&S contact you.