ME Safety Experience Report Form
If you experienced or observed an incident, an accident, or an 'almost!' situation, please report it here. This form is anonymous and secure. The contents will be communicated to our academic laboratory communities and used to prevent safety issues in the future.
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Attention getting title *
Please provide a title of five words or less that describes the incident
Please describe the incident without using identifying terms such as names, room numbers, etc. *
If relevant, include information about time of day, whether the researcher was alone when the incident happened, whether an injury resulted, what response was taken, reagents, temperature, amounts, what controls were used (fume hood, PPE ) etc.
What could be done in the future to prevent this incident from happening again? *
If relevant, include suggested new controls(fume hood, PPE ), changes to procedures, new group policies etc.
If you are open to being contacted or would like to have someone contact you to discuss this further, you may provide your email here.
This form is anonymous and this question is NOT REQUIRED. Optional for those interested.
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