Hazard Reporting Form

Hazard Reporting Form

Note: The purpose of this form is to identify hazards on our campuses so they can be addressed.

Thank you for taking the time to fill in this form; by doing so you are making Algoma University a safer place for all of us. If you find a hazard and rectify it, it is still important that you fill in this form.

Email:*

Kindly enter your Algoma University Email Address below

Campus/Site:*

Kindly mention the campus/site of the Hazard

Sault Ste. Marie

Timmins

Brampton

Creekbank

Date:*

Kindly mention the date when the hazard was observed

Type of Hazard:*

Kindly specify the type of Hazard below

Select or enter value

Please specify:*

Kindly specify the type of hazard

Location of Hazard:*

Kindly specify the location where this hazard took place(building, floor, room...)

Hazard Details:*

Kindly describe the hazard in details below

Were you able to rectify the hazard?*

Yes

What corrective actions did you implement?*

Kindly be specific on the corrective actions taken by you

Did you notify someone about the hazard?*

Yes

Who did you notify?*

Kindly mention the person you notified about the incident

What caused it?*

Kindly mention what you think could have been the potential cause for the hazard

Recommendations/Further Actions Required:*

Kindly drop-in your recommendations for what else could have been done

File Upload

Kindly upload your pictures here.

Drag and drop files here or

Send me a copy of my responses

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