Report an Unsafe or Potentially Hazardous Condition admin    |    cwu home     

It is in everyone's best interest to report potential hazards on campus so they might be dealt with appropriately. Please use this form to report hazards or near-miss situations to help prevent future incidents on the University campus.

Describe the potentially hazardous condition or near miss, the location, date, and any other details that will help FMD investigate and address the issue. If you have a proposed solution, we welcome your suggestion.

Department:          Building / Area:*         Room Number:
Date Condition was Observed:*          Time Condition was Observed:     Name (optional):
Designation:*      Employee      Student     Visitor          Other Designation:
 
Other Contact Information (optional):
 
Description of Condition or Near Miss:*
Additional Comments or Suggestion:
 

All reports of hazards and corrective measures/actions taken will be documented and followed up. Supplying a return email address is optional. If an email address is supplied, the reporting individual will be notified of the corrective action taken.

 

   
   
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