Injury & Illness Prevention Program

Hazard Reporting Form

UCSB employees and students may use this form to report any unrecognized, or uncontrolled safety issues to Environmental Health & Safety. EH&S will investigate the safety issue to determine if mitigations are needed. Form can be submitted anonymously if desired. Employees are advised that it would be illegal for an employer to take any action against an employee in reprisal for exercising their rights to report safety issues.

If you encounter problems submitting the form online, you can download a PDF version of this form here and submit it via campus mail (MC: 5132) or fax (805.893.8659).

Your Information (Optional)
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.