Incident Report • CampusOptics

Incidents reported through this form are not part of emergency communications to triage the incident while it's still happening. Incidents should only be submitted after the emergency has been addressed and there is no immediate threat to life or health.

Order of operations for fire, serious injury, or immediate threat to life or health:

Dial 911 to dispatch emergency services.
Contact supervisor, adjacent occupants, and building manager.
Dial 940-565-2109 during business hours to speak with EHS. After hours, EHS on-call personnel will be contacted by UNTPD dispatcher.

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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INCIDENT INFORMATION

Date of Incident* Required

Principle Investigator* Required

Department name* Required

Detailed description of incident* Required

Individual(s) involved in the incident* Required

Faculty
Staff
Graduate student
Undergraduate student
Guest

List names and department of individuals involved in the incident:

Estimated level of exposure received

Was the individual injured?* Required

Did the individual receive medical treatment?* Required

If yes then where? If no, then why not?* Required

Authority contacted* Required

LASER DETAILS

Make and model of laser/equipment involved

Maximum power (W)

Type (HeNe, Ar, Sapphire, etc)

Mark the laser class that was involved.

Power output at time of incident (W).

Mark the wavelength of the laser

Laser Maximum Permissible Exposure (MPE)

PROTECTIVE EQUIPMENT

Was the individual wearing protective eyewear?

Was the individual wearing gloves?

Was the individual wearing a lab coat?

Was the individual wearing other protective equipment?

Add Supporting Documents

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