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
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?
Banta Elementary School
Butte Des Morts Elementary School
Clovis Grove Elementary School
Gegan Elementary School
Jefferson Elementary School
Nathan Calder Stadium
Nicolet Elementary School
Maplewood Middle School
Menasha City Center District Office Building
Menasha High School
Other Location Describe in Comments
Area of concern
Room Number (if applicable)
Date of Safety Concern or Near Miss?
Time of Safety Concern or Near Miss?
Affiliation with the School District?
Prefer Not to Say
Safety Hazard, Concern or Near Miss Type
Unsafe "Other" Explain in comments
Slip, Trip and and Fall Hazard
Cut and Abrasion Hazard
Exposure - Temperature Hazard
Comments describing the hazard concern or issue?
Name (not required but helpful)
Email (not required but helpful)
Contact Number (not required but helpful)
Never submit passwords through Google Forms.
This form was created inside of Menasha Joint School District.