Report a Safety Hazard

Would you like to remain Anonymous?

Yes

Contact Information

First Name

Last Name

Phone

Department

Location

Building

Specific Room/Area

Details

Date the hazard was observed

Time the hazard was observed

Please indicate AM or PM.

Please provide a description of the potential hazard. (Please be as detailed as possible)

What changes would you recommend to correct the unsafe condition or hazard?

File Upload

Please upload any relevant documents, pictures, or other files.

File Upload

Injury Report

If you need to file an injury report please see the links below for reference.

EFR (Injury Report) Instructions
EFR (Injury Report) FAQ Sheet
EFR (Injury Report)

Salesforce Record IDs (All these fields should remain hidden)

Case ID

Contact ID

Record ID

UC Location ID

Account ID

For security purposes, do not include any private information in this form such as credit card, social security numbers, or private health information.