Incident Reporting - Student Injuries, Property Damage, & Emergency Spills

Incident Report Form (other than Motor Vehicles)

All Student Related - Incident Reports (Motor Vehicle, Injuries, Property Damage, and/or Emergency Spills) are required to be submitted within 24 hours of the event. The Incident Report Form on this page is for student injuries, property damages, and reportable spills only. If the incident involves a motor vehicle, complete and return the Motor Vehicle Accident Report

Lab Specific Info:
  • As a general rule, a small (non-emergency) spill of a chemical that can be wiped up with a paper towel is not considered a reportable lab accident, but is considered general  housekeeping. Any large spills, extremely hazardous spills, spills requiring neutralization or spills involving other damage should be reported and must be addressed by faculty or staff (see Cal Poly Humboldt's Spill Response guidance document).
  • Getting chemical on oneself that requires either copious flushing for 15 mins or more(not simple handwashing), changing of clothes, neutralization, treatment or is toxic by absorption, corrosive or otherwise hazardous to health(carcinogenic, teratogenic, sensitizing etc...) MUST be reported on this form.
  • All spills of any chemical on a student or to determine if it is a housekeeping spill or a "reportable accidentmust be reported to the faculty for assessment in all cases. If unsure whether it should be reported on the form, choosing to over-report so that tracking and trending can occur, to ensure EH&S can follow-up as needed is best. 
If this is employee related, complete the Supervisor's Report of Injury Form and/or the Motor Vehicle Accident Report & State Driver Accident Review if applicable. Also have the injured employee complete a DWC-1 Form (Employee Claim Form).