REPORT A SAFETY CONCERN

The Environmental Health and Safety Department and the College of St. Benedict Safety Committee seek input from faculty, staff, and students that identifies safety hazards, unsafe conditions, or unsafe work practices. This form may be used to submit a safety issue for consideration by the Safety Committee.

PLEASE NOTE: Safety Concern submissions reach the CSB Safety Committee without the sender's name or e-mail address unless this information is provided.

Thank you!

I wish to submit a

Subject

Location

Please enter your issue, ask your question, or make other safety-related input in the space below.

Is there an action that you recommend the Safety Committee take in regard to this communication?

Please indicate your status,

Would you like a reply to your Safety Issue Submission? If so, please provide your name and a daytime telephone number and/or e-mail address where we might reach you. If you leave the boxes below blank, your submission will be completely anonymous.

Name

Phone Number

Email Address

Forms Manager

REPORT A SAFETY CONCERN