Safety Recommendation Form

To report any health & safety concern at Washington University in St. Louis, please fill out this form, describing your concern, in the comment section below, and then submit the form when you are finished. In order to properly follow-up on the concern you submit, we encourage you to provide your name and e-mail address so the appropriate Environmental Health and Safety staff can contact you to gather the necessary information. However, if you would like to make an anonymous submission, leave e-mail, name and phone fields blank.

Name:	(optional)
Campus:
Department:
Location:	Please enter a location.
Phone:	(optional)
Email:	(optional)
Check on the boxes that apply:	Indoor Air Quality (e.g. mold, dust, odors, temperature, etc.)
	Asbestos
	Vehicle / Bicycle / Pedestrian
	Walking Surfaces (ice, uneven pavement, potholes etc.)
	Construction
	Fire Safety
	Slip, trip and fall hazard
	Hazardous Material (Biological, Chemical, Radioactive)
	Lighting
	Noise
	Safety Training
	Security
	Ergonomics
	Disaster Preparedness
	Other Please select at least one check box.
Brief Description:	Please provide a brief description of the safety recommendation or concern.