Instructions: Use this form to identify any unsafe conditions and/or practices at the University of California Riverside. Please note that this form is not to be used to report emergencies or eminent danger. Dial 911 to report emergencies.
Description
What is the hazard? ✻
When did it occur ✻
Where is it located?(Building, Room #) ✻
How do you suggest we fix it?
Contact information
Name(Optional)
Email:(optional)
Phone number(Optional)
For Office Use Only
Comments
Status
