Near Miss or Hazard Reporting Form

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Email(Required)

Date of Near Miss or Observation of Hazard(Required)

Building Or Parking Lot(Required)

Specific Location Room, Lab, or Shop # (e.g., Room A1216)(Required)

Please describe what needs to be fixed or addressed.(Required)

Do you have any suggestions for a resolution/prevention?(Required)

Describe the situation or observation.(Required)

Attachments

Do you have pictures related to your observation?

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Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB, Max. files: 5.

Risk Management