Report a Hazard or safety concern

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Where? (be specific)

Name:

Department:

Building:

Room:

Phone:

* Required E-mail:

Date/time of incident:

Nature of Concern:

What is the problem?

What changes would you recommend to correct the unsafe condition?

Have you informed your supervisor?

Yes
No

To better assist you, please provide us with an idea of the immediacy of this concern:

Immediate hazard could lead to serious injury
Not an immediate hazard but creates and unpleasant work environment
For your information

Response Form

Report a Hazard

Use the form below to report a safety concern to Environment, Health & Safety (EH&S). Or, to report:

Imminent hazards or threats or emergencies:
- Inform your supervisor, manager, or department head
- Call Environment, Health & Safety: (608) 265-5000, M-F, 7:45 a.m. – 4:30 p.m.
- Call Campus Police: (608) 262-4524, after-hours and weekends

If you are concerned about a hazard or potential hazard within your department or building, please complete the following. This will assist our staff in determining the best way to address your concerns. If you are experiencing an emergency, please dial 911 or call our office (265-5000) for immediate assistance.