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Hazard Report

Augustana College is responsible for maintaining a safe work environment. A safe work environment is one free from accidents, injuries and work related illnesses. All Augustana College employees should work together in order to maintain a safe environment for all employees, students and visitors.

Augustana College employees and faculty are encouraged to use this form to report safety issues to Environmental Health & Safety. The Safety Committee will investigate the issue/hazard and determine the actions to be taken. This form can be submitted anonymously. Employees are advised that it is illegal for an employer to take any action against an employee in reprisal for exercising their rights to report safety issues.

Please fill out the following form. If you prefer a paper form, please click here, and return the completed form to the HR Office on the second floor of Sorenson Hall.

Date: *
Time: *

Name (optional): *
Department (optional) : *
Phone and/or Email (optional):
Describe Hazard, Work Condition or Work Practice:*
How long has this hazard existed
Has this Hazard been reported to your supervisor?
Do you wish to be notified of the action taken?
If yes, be sure to fill out the contact info above.