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

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 EH&S 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 EH&S 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):




CAMPUS: Human ResourcesInsurance & Risk Management

MEDICAL CENTER: Workers' Compensation