Employee Hazard Report

 

All faculty members, staff, students and visitors at Kutztown University 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 campus community can participate in making the campus 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.

Employees are advised that use of this form or other reports of unsafe conditions or practices are protected by law. It would be illegal for the employer to take any action against an employee in reprisal for exercising rights to participate in communications involving safety.

Description of the unsafe condition or practice:

Has this matter been reported to the area supervisor, EHS, or Dept. Chair? No Yes

Would you prefer your personal information to be held confidential? No Yes

Employee Name:  

Employee Phone: 

Employee Email:  

Department: