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College of the Sciences

Near-Miss Report

Complete this form to report near misses in the Chemistry Department. This form can be used to report unsafe actions by anyone in the department, report unsafe situations, or report scenarios that given different events could have resulted in an emergency.

Reports will be reviewed by the Department Safety Officer and these reports can be made anonymously.

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This field is NOT required. Near misses can be reported anonymously.
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Please indicate where the near miss occurred or where the safety issue is present. (Be specific as possible)
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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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