Imminent hazards to life and health should be reported immediately to your supervisor or Environmental Health & Safety at ext. 5711. For other hazards, submit this form to EHS.
Date Identified:
Location of Hazard (building; room; other description):
Description of Hazard (such as tripping hazard, cluttered areas, unsafe work practices, personal protective equipment not easily accessible, etc):
Recommendation for Correction:
Yes No
Optional Information
Email Address:
Department:
Telephone Number:
Environmental Health & Safety • 1 Harpst St., Arcata, CA 95521 SBS 409 • 707.826.5711 • Contact Us.
