Report a Safety Hazard or Concern

Please use this form to report a safety concern or safety hazard directly to SE’s Public Safety Department. This is your opportunity to promote safety awareness at SE.

Please call the SE campus emergency number (ext. 2727) immediately to report emergencies that are an immediate threat to life or health. Work-related injury or illness should be reported to employee’s supervisor.

Name (First, Last)

Address

Your Email

Would you like this report to be kept confidential?
 Yes No

Where is the location of the safety hazard or safety concern? Please be as specific and descriptive as possible.

What is the nature of the safety hazard or safety concern?

If you have reported this hazard or concern before, when and to whom?

Did you receive a response from the previous report? Please detail the response you received.

Questions or Comments

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