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EH&S Hazard Report
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.
Contact Information
Name (Optional)
Department
Email Address
Phone
What is the hazard?
*
Date of Incident
*
+
Time of Incident:
Where is the hazard located? (Building)
*
0/255 characters
Room #
*
How do you suggest we fix it?
0/255 characters
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