This report, when submitted, provides the Office of Biological Safety (OBS), Occupational Medicine and the Institutional Biosafety Committee (IBC) with information to ensure that proper actions have been taken, including appropriate medical care, and helps the University meet regulatory reporting requirements.
Please note that this report does not replace injury reports for Workers’ Compensation claims. For information and instructions on Workers’ Compensation, please visit the Risk Management website.
If you are reporting an emergency situation in which there is an immediate threat to health or life, please call 911.
- Use this form to report any and all potential exposures or releases of organisms, cells, or biological toxins on UW–Madison campus and laboratories.
- Reporting must be completed within 24 hours of the event, and is the responsibility of the Principal Investigator (as stated in Institutional Biosafety Committee (IBC) Policy on Reporting Exposures, Injuries, Releases and Other Incidents – UW-Madison Policy Library (wisc.edu)).
- Potential exposures include needle sticks, animal bites or scratches, aerosol exposures, mucosal splashes, and other incidents resulting in potential exposure to biohazardous materials or harm to health.
- Potential releases include spills outside of primary containment as well as potential releases to the environment.
- Unauthorized escapes or releases of transgenic vertebrate or invertebrate animals or plants should also be reported on this form.
- After completing this form, select “Submit” at the bottom of this form. The information on this form will be sent to designated individuals at the Office of Biological Safety and Occupational Medicine
- Information on this form is used to determine how our offices may help you and your laboratory and for mandatory federal reporting purposes.
- Any individuals involved may be contacted for incident follow-up.
- Occupational Medicine will attempt to contact the individual impacted in the event: however, individuals are encouraged to call Occupational Medicine, 608-265-5610 or seek care elsewhere (e.g. Urgent Care or Emergency Department).
- If you need assistance completing this form or reporting an incident, please call the OBS at 263-2037.
- After successful submission, a confirmation email will be sent to the Contact Email listed on the form. If this confirmation email is not received, an error has occurred. Please contact OBS at 263-2037 for assistance.