Employee Safety Suggestion or Report of Hazard Form

This form is for use by any faculty, staff, or volunteer who wishes to provide a safety suggestion or report a hazardous workplace condition or provide a safety suggestion or report a hazardous workplace condition or practice. Complete this form and return to your manager or Risk Management.

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Complete this section with your name, department and extension.


*if you wish to remain anonymous, do not complete this section

Please submit your full name which we will use as a form of signature

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