Hazard Report Form

Reporting a Safety Concern on Campus
It is now possible to report a safety concern or safety suggestion online directly to the Environmental Health and Safety department. This is an excellent opportunity for the campus community to become involved in safety and promote awareness.

Types of safety concerns to report here may include:
      General workplace and office safety
      Fire safety
      Laboratory safety
      Environmental issues

DO NOT USE THIS FORM TO REPORT AN EMERGENCY OR AN IMMEDIATE LIFE THREATENING HAZARD. Call Campus Police for immediate emergencies at 585-2677.

Do not use this form to report an injury or illness sustained on the job. You may wish to report to us the hazard that caused the injury, but you must report all workplace injuries to the Worker's Compensation office. If you are not an employee of the University, you should report all injuries to Risk Management at 581-5590.

If you would like to report hazardous materials for pickup, please see the Hazardous Materials pickup and disposal procedures page.

If you would like a confirmation that your report was submitted,
or a hard copy for your records, please print the web page that
will appear here after you click the "Submit this form" button.

Reported by:
University Affiliation:
Email address:
Department
Building/Room
Telephone:
Location of safety concern:
Please describe the safety issue:

Have you reported this before? If so, to whom?

Other comments: