EHS Incident Report

First name of person reporting the incident
Last name of person reporting the incident
Phone number of person reporting the incident
Employment/educational status of person reporting the incident
EHS incident date and time
EHS incident date and time: Date
EHS incident date and time: Time
EHS incident type

If the EHS incident resulted in an injury, please complete the Human Resources Incident-Injury/Illness Investigation Report form and submit to hrmail@rpi.edu

If the EHS incident resulted in an injury, please complete the Human Resources Incident-Injury/Illness Investigation Report form and submit to hrmail@rpi.edu

If the EHS incident type was "Other", please describe:
Specific incident location
(i.e., JEC 2205, West lot by West Hall bridge, etc.)
In your own words, please describe the EHS incident and what occurred
Please list the names of any witnesses to the incident
(If applicable)
Provide specific information about involved equipment
(If applicable, list equipment name, manufacturer, model, serial number, etc.)
How did you and/or others involved with the incident respond?
(i.e., Called public safety, initiated spill response, contacted supervisor, etc.)
Upload an Image
Upload an image if applicable 
Maximum 3 files.
100 MB limit.
Allowed types: gif, jpg, jpeg, png.

Offices located at 41 Ninth Street.

Director of EHS (518) 276-6114

Staff Directory

EHS

Report an Incident or Accident
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