Hazard Hero Report
Appalachian State University campus safety hazard reporting form.
Sign in to Google to save your progress. Learn more
Would you like your contact information to remain confidential? *
Providing your contact information will help us better address your safety concern should we have any follow-up questions, as well as allow our office to provide you with updates.  If you select yes, any contact information you provide will not be shared outside of the EHS&EM office.
Name
What is your affiliation to the University?
Clear selection
Department
For faculty and staff only
Email
Phone
Location of the unsafe condition or act *
Include building, room number, and other specific location information.
Date the unsafe condition or act was observed *
MM
/
DD
/
YYYY
Please provide a detailed description of the unsafe condition or act. *
How do you think this unsafe condition or act can be corrected?
Have you reported this to your supervisor?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Appalachian State University. Report Abuse
Google Forms