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. Reports may 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 (http://www.ehs.ucsb.edu/files/docs/ii/Hazard_report_form.pdf) and submit it via campus mail (mail code 5132) or fax (805.893.8659).

Hazard, unsafe condition or practice *
Your answer
Location: *
Your answer
Suggestion for improving safety:
Your answer
Has this matter been reported to your supervisor?
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