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* Response Procedures
1. In the event of a large fire, pull the fire alarm or call 911 evacuate the lab.
2. If your clothes ignite, DO NOT PANIC. To extinguish the fire:
a. Get under a safety shower; or
b. Stop drop (to the floor), and roll
9.12 Reporting Accidents
All injuries must be reported to the EH&S and lab Management. Accident forms area available in labeled red
folders, kept in the in the front office area or lab office. See UCI Environmental Health and Safety UCI
EMERGENCY PROCEDURES BLUE FLIP CHART for information on how to report injuries, or see
EH&S website: www.ehs.uci.edu/apps/hr/index.jsp
* Accident/Incident/Exposure Form:
This from must be submitted in the event of injury of any personnel, UCI or non-UCI. This form must be
submitted to EH&S and lab Management within 24 hours of injury and signed by the injured party and an
UCI staff personnel. This form is available online at: www.ehs.uci.edu/apps/hr/index.jsp
* Employee’s Claim for Workers’ Compensation Benefits:
This form must be submitted in the case of injury of UCI personnel. This form must be signed by a University
representative/supervisor/administrator and then given or mailed to the employee within 24 hours of the
accident, incident or exposure. The form and a detailed instruction sheet are available at:
www.ehs.uci.edu/apps/hr/index.jsp
*Report of Serious Injury
• Report all serious injuries immediately to EH&S. UCI must report any employee related
serious injury, illness, or fatality, within 8 hours to an outside agency.
* Employer’s Report of Industrial Injury (Cal-OSHA Form)
This from must be submitted within 24 hours of occurrence when an industrial injury or occupational disease
suffered by a UCI employee results in
• Lost time beyond the day of injury, or
• Medical treatment by a physician in clinic, hospital, emergency room, or medical office.
* A Workers’ Compensation Lost Time Report
Form must be submitted when a UCI employee has lost one full day or more following the day of an accident
or the first day of a work related illness. Form is submitted online when the employee returns to work.
The form can be found at: www.ehs.uci.edu/apps/hr/index.jsp
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