LIGO Safety Incident Report Form

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On submission, PDF copies of this report will be sent to the originator, the reporter's immediate Manager, the site Operations Manager, the LIGO Safety Officer (Danny Sellers), and the Chief Operations Officer (Hannah Hansen) of the LIGO Laboratory.

Instructions

Please provide as much detail about the incident as possible.
Preferred formats for supporting documents are pdf and plain text, but other formats may be submitted. Supporting documents in other formats may not appear in the initial generated report, but they will become part of the record.
Filenames of supporting documents are restricted to alphanumeric characters, dashes, underscores, and dots (periods). Please do not use any spaces or other characters in the filenames.
For information regarding safety incidents, please contact the LIGO Safety Officer:
Danny Sellers
LIGO Safety Officer
LIGO Livingston Observatory
19100 LIGO Ln
PO Box 940 Livingston, LA 70754

Office Phone: 225-686-3135
Cell Phone: 225-276-6673
Email: dsellers@caltech.edu

Type Of Investigation: Unsafe Condition Injury Property Damage Security Illness Good Catch! Other	*Please provide any comments regarding the type* of the investigation that you feel are pertinent:**
Facility/Site Location:	LHO LLO CIT MIT Other
Employee Involved:
Additional Employee:
Additional Employee:
Date Of Incident
Time Of Incident:
Report Form Submitted By:
Reporter's email:	(Use your @LIGO.ORG email if you have one and you will be able to download a copy of your report immediately.)
Group Leader Email:	@LIGO.ORG

Upload a supporting PDF formatted document:

Upload an additional supporting document (any format):

Describe the Accident/Incident in detail. Describe what each person involved was doing at the time the accident occurred. List factors that you feel may have contributed to the accident. Describe injuries and property damage in detail.
Please take your time and be thorough. You are encouraged to cut and paste a text document prepared elsewhere, or to upload a pdf formatted document which will be merged into the report.

Please be certain that you have filled out the form completely before you click!