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Your name:
Name of your primary PI
Berger
Bates
Bilodeau
Cai
Calliari
Carta
Choi
Davis
Epling
Ford
Geise
Giri
Green
Griffin
Highley
Koenig
Lampe
Lazzara
Letteri
Paolucci
Taylor
Taite
Other / NA
Prpich
Vechiarello
Would you describe this as an incident or near miss?
Incident
Near miss
Describe the incident/near miss by clicking all relevant descriptors
Chemical/substance exposure
Chemical/substance spill
Gas release
Fire incident
Explosion
Equipment malfunction
Broken glassware/equipment
Accidental needle-stick
Slips,falls,cuts
Risky/unsafe behavior or horseplay
Other
Briefly describe the incident/near miss. Please include the location and time of day.
Please add a photo of the incident/near miss if applicable.
Drop files or click here to upload
Was anyone injured?
Yes
Maybe
No
What actions have been taken to manage the near miss? Check all that apply.
Informed PI
Informed Lab members
Informed EHS
Informed ChE Safety Committee
Steps to resolve issue have been taken
No actions have been taken
Would you like to follow-up with the Safety Committee?
Yes, although the issue was resolved
Yes, the issue still needs to be addressed
No, the issue was addressed
Thank you for your reporting. Please use this
link
to report an accident, safety concern, or hazardous situation to EHS
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