Safety Concern or Near Miss Report

Use this form to report safety concerns or near miss incidents on UAH's campus. You can submit this report anonymously, or you can indicate if you wish to be contacted for further questions.

This does not replace the F&O work order system.

Some examples of concerns:

Witnessed an unsafe act that you want OEHS to investigate.
You want to voluntarily report a near miss incident.
You have a concern about an environmental issue (stormwater, pollution, etc.)

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Anonymous Submission

This submission will be anonymous. No reporter information will be collected, but all of your responses and form information will be submitted.

Location

Name* Required

Additional Location Details

Exact Location

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Additional Information

University Affiliation:

Do you want to be contacted if OEHS has questions or to be updated on the status of your submission?* Required

Date Occurred

Add Supporting Documents

Add files to upload as supporting documentation along with your incident.

Reporter Info

Anonymous Submission

Location

Report Type

Additional Information

Add Supporting Documents