Hazard Hero Report
Appalachian State University campus safety hazard reporting form.
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
Your answer
What is your affiliation to the University?
Department
For faculty and staff only
Your answer
Email
Your answer
Phone
Your answer
Location of the unsafe condition or act
Include building, room number, and other specific location information.
Your answer
Date the unsafe condition or act was observed
MM
/
DD
/
YYYY
Please provide a detailed description of the unsafe condition or act.
Your answer
How do you think this unsafe condition or act can be corrected?
Your answer
Have you reported this to your supervisor?
Submit
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