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Safety Concern Report
Building Name *
Location in Building *
Observer Name *
Date Observed *
Hazard Type *
Physical Hazard - risk for slip/trip/fall, unguarded machinery
Physical Hazard - risk for slip/trip/fall, unguarded machinery
Ergonomic Hazard - risk of fatigue or strain
Ergonomic Hazard - risk of fatigue or strain
Chemical Hazard - cleaning solutions, fumes, ventilation
Chemical Hazard - cleaning solutions, fumes, ventilation
Biological Hazard - organic materials, bodily fluids
Biological Hazard - organic materials, bodily fluids
Other (Please Specify)
Other (Please Specify)
Image of Concern
Please upload an image of the concern, if one is available
Comments *
Please describe the concern in detail
Submit
Submit a Work Request (On Campus Only)
Chimera Safety Data Sheets (SDS) Online
Chimera Chemical Inventory (Approved Users)
FM Intranet
IF YOUR EMPLOYEE HAS BEEN INJURED AT WORK
REPORT A SAFETY CONCERN (On Campus Only)
