Report a Concern Regarding an Environmental Health & Safety Issue

This form can be submitted with or without your identifying information (below). We prefer that you identify yourself so that we can contact you if additional information is needed and provide feedback about the resolution of the issue.  Even if you provide your contact information, your confidentiality will be protected, to the extent it is legally possible to do so. 

After submitting this form, the EHS Director will investigate the concern you have reported.

Please provide the following details, e.g., regarding an unsafe practice or compliance issue:

  • Description of the incident
  • Details on how you became aware of the incident
  • Location of the incident (building name, room number, PI or area supervisor’s name, etc.)
  • Date of the incident
  • Name(s) of the personnel involved
  • Whether you have reported this incident to anyone else, and if so, what action was taken.
Describe the incident, activity, or concern
There needs to be sufficient detail to permit an investigation to take place. Please provide as much information as you can.
Contact Information (optional)