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REPORT OF A HAZARDOUS CONDITION

Use this form to submit a report of a hazardous condition, safety concern, or "near miss" accident in your workplace or anywhere on campus.

It is hoped that these reports can provide information regarding where, how, and what types of accidents each department is having, so that we can focus our efforts on implementing effective programs to reduce the accidents. The ultimate goal is to provide a safe and healthful environment for WVU faculty, staff, students, and visitors.

NOTE: This information will be placed into a database maintained by EH&S.
Our desire is for the users to provide this information to Environmental Health and Safety without fear of reprisals. If such a fear exists, only fill-out the required (*) sections of the report so that we can determine any corrective actions that are necessary.

Last Name:
First Name:
Phone:
*Department:
Supervisor:
E-mail:
*Date:
*Location of the hazardous condition you wish to report. (Please be as specific as possible, include building and room numbers, if applicable.)
*Description of the near miss incident you wish to report (Please be as specific as possible, including description of equipment or processes involved if applicable.)

   Web Site Questions and/or Comments:
  EHSContact@mail.wvu.edu

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