Confidential/Hazard Report

All faculty members, students and visitors at USA have an obligation to perform their work in a manner that does not endanger their health and safety, the well-being of others, or the university environment. Members of the university community can participate in making the university a safe place to work, study and live by identifying health and/or safety hazards or unsafe conditions by informing those responsible for the problem area. This report will be held in confidence.

Description and location of unsafe conditions of practice:

Has this matter been reported to the area supervisor, MSO, or Dept. Chair?

Would you prefer your personal information to be held confidential?

Name

Phone

Email

Department

Building