Report a Safety Observation

Report a Safety Observation

Please use Google Chrome or Microsoft Edge to complete this form.

Date safety concern observed:*

Campus where the safety concern is located:*

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If "Other off campus location(s)" was selected, please describe:

Site-specific Location *

Building, floor, outside area, rooftop, etc

Is the safety concern an imminent threat?*

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If you selected "Yes" to imminent threat, please follow the steps below.

2. In the area below include the date and time CRC was contacted

3. Brief overview of CRC's response and recommended actions

After speaking with CRC please complete the remaining sections of this form.

Please describe the safety concern:*

Are there currently employees and/or contractors working in this area?*

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If "Yes" was selected, please provide the following:

Is this area accessible to the public?*

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Have you contacted the FPM Customer Resource Center (CRC) regarding this concern?*

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If CRC has been contacted, was a Work Order created?

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What recommended corrective measure(s) can be done to control/eliminate the situation?*

Do you have any suggestions for the FPM Health and Safety team regarding opportunities for improvement for our safety culture?*

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If "Yes" was selected, please describe:

Include any additional information you'd like to provide:

File Upload

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Would you like a follow up?*

If you select "No", your submission will remain anonymous.

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If you selected "Yes" and would like a follow up, please enter your email below: