Safety Hazard and Near Miss Reporting
Reporting of safety hazards or near misses help make our district an overall safer place to learn and work. These reports help us to identify and correct a hazard before it becomes an accident. You may report anything that you feel unsafe about or just want to inform the district on a certain safety item.

Please complete this form as a means of communicating these items and help prevent future incidents at Menasha Joint School District. Please know that reporting a concern is never wrong and no blame will ever be held. The sole purpose is to correct a concern before it becomes something that could hurt someone or thing. If you have any additional questions or safety concern, issue or near miss pictures to share please send them to safety@mjsd.k12.wi.us

For questions or cases deemed immediately dangerous to life or health, call Facilities at 920-209-9693. In the case of an emergency, call 911 immediately.
What Building is the concern about? *
Area of concern *
Your answer
Room Number (if applicable)
Your answer
Date of Safety Concern or Near Miss? *
MM
/
DD
/
YYYY
Time of Safety Concern or Near Miss? *
Time
:
Affiliation with the School District? *
Safety Hazard, Concern or Near Miss Type *
Required
Comments describing the hazard concern or issue? *
Your answer
Name (not required but helpful)
Your answer
Email (not required but helpful)
Your answer
Contact Number (not required but helpful)
Your answer
Submit
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