Incident Report • CampusOptics

Please provide the following information in your request. This information provides valuable

information used during the assessments.

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Department

Title

Have you had an ergonomic assessment before?

Is this request due to an employee injury report?

Work schedule / days per week and hours per day:

Are you experiencing any physical symptoms?

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