Instructions: Use this form to register as a Safety Partner (BES, BSEC, and/or DSC). All fields are required to be completed.
First Name: ✻
Last Name: ✻
Email: ✻
Phone number:
Department: ✻
Name of Department Head:(Director, Dept. Chair, Unit Head, Laboratory Manager / Director)
Location (Building, Room #):
What type of safety partner would you like to register as?
If registering as a BES or BSEC, which building are you registering for?
Comments:
For assistance with this form or for more information regarding Safety Partner roles, please contact Office of Emergency Management by email or phone (951) 827-5528.