Safety Hazard / Near Miss Reporting Form

A Safety Hazard is defined as any condition which might be dangerous to faculty, staff, students, or visitors at FAU or something that could result in damage to University property.

A Near Miss is defined as an unplanned event that did not result in injury, illness, or damage, but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality, or damage from occurring.

Complete the following information when it is believed a safety hazard exists or a near miss has occurred. Contact information, though optional, is particularly helpful when reporting a near miss. Clicking the SUBMIT button will cause a report to be electronically submitted to Environmental Health and Safety.

If you see this don't fill out this input box.

Name

Telephone

Affiliation

To which Campus or site does this report pertain?

Other

Please provide information about the safety hazard or near miss you wish to report. Describe the problem, the location, and any other details that will help in addressing the hazard. If you have a proposed solution, please feel free to provide it as well.

Enter Information *

THANK YOU FOR TAKING THE TIME TO HELP KEEP FAU SAFE!