Incident Report • CampusOptics

University of Texas at Tyler ~ 3900 University Blvd. Tyler, TX 75799

This Safety Concern Form will be evaluated by an Environmental Health & Safety representative and an investigation will be conducted. Please complete this form and it will be automatically submitted to EH&S.

Emergency Phone Numbers:

Environmental Health and Safety: (903)-566-7011
UT Tyler Emergency Dispatch: (903)-566-7300
Physical Plant: (903)-566-7431

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Safety Concern Form

Please select your current status:* Required

Is there an immediate life threatening danger to the University Community?* Required

Description of safety concern (unsafe act or conditions):* Required

Select all those affected by the unsafe situation:

Students
Employees
Contractors
Visitors
Other

Describe other

Please write a recommendation to remedy the safety concern:

Add Supporting Documents

Add files to upload as supporting documentation along with your incident report.