Form should be completed within 24 to 48 business hours of injury or illness occurring. Copy of the completed form will be provided via the email address provided on the form. The UTA Environmental Health & Safety Office (EH&S) reviews and investigates injury and illness reports to ensure corrective actions are implemented to prevent future occurrence. You may be contacted by an EH&S staff for further details after the report is reviewed.
When completing the "Location" section of the form, if your Building/Outdoor Area does not appear, please type/select "Other" and enter information into Additional Location Details.
Note: If needed, report may be provided after investigation but you may print a copy of the submission for records.
The UTA Environmental Health & Safety Office can be reached at ehsafety@uta.edu or via phone at (817) 272-2185.