Report a Safety Concern

You are encouraged to report unsafe conditions and near misses that you observe on campus without fear of reprisal using this form.  These may include health and safety risks (such as trip and fall hazards or unsafe conduct by employees or students), unsafe driving practices (such as golf carts or maintenance vehicles driving on walkways or pathways too fast), fire safety issues (such as faulty wiring or equipment or tampering with fire safety and equipment), security issues (such as doors propped open), environmental concerns (such as improper disposal of chemicals), and indoor air quality concerns (such as unusual odors).

This form should not be used to report situations that require immediate attention.  University Police may not receive this form in time to provide assistance.  If you are reporting a situation that requires immediate attention, please call 911. It is also not for routine maintenance problems, such as air or heating concerns, sprinkler breaks or pest control.  For such reports, please contact Facilities Services by phone at (209) 667-3211, by email, or you may complete a work order by clicking here. But if you have observed a non-emergency condition that you think may create a health or safety risk for you or another person, please report that condition.

Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png.
If 'other', please list the department names.
If injuries occurred, please fill out these sections as well.
The following information is optional, however if you would like for someone to follow-up with you please complete the information below. By leaving the fields blank you are choosing to remain anonymous and will not receive confirmation that the concern was received.

This form meets the requirements of Cal/Osha Subchapter 7 - General Industry Safety Orders, Section 3203 (a)(3):

Include a system for communicating with employees in a form readily understandable by all affected employees on matters relating to occupational safety and health, including provisions designed to encourage employees to inform the employer of hazards at the worksite without fear of reprisal.  Substantial compliance with this provision includes meetings, training programs, posting, written communications, a system of anonymous notification by employees about hazards, labor/management safety and health committees, or any other means that ensures communication with employees.