1.  Nature of the incident:  (Check all applicable)

	Exposure		Facility System Failure		Injury

 

 

	Inoculation		Ingestion		Dermal
	Inhalation		Mechanical Problem		Hazardous Material Spill

 

 

 

 

 

 

 

 

 

3.  Date and time of incident:

 

 

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4.  Person(s) involved:

 

 

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5.  Precise location of incident:

 

 

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6.  Description of incident:  (Include hazardous materials involved and exactly how the incident occurred)

 

 

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7.  Corrective action taken:

 

 

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8.  Faculty/Hazardous Material User:

 

 

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9.  Date:

 

 

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Copy To:

 

Director of OU Police

Office of Environmental Health and Safety