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).

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