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Grenfell Campus - Report a Hazard Observation

GUIDELINES

Report a Hazard Observation - Grenfell Campus

This form has been created to allow all members of the University community to report a Hazard Observation (source, situation, or act with a potential for harm in terms of human injury, illness, property damage, or a combination of these). The report will be assigned to the proper resource within the University for follow-up.

Please Note

While this resource is available for reporting 24 hours a day, 7 days a week; the system is not be monitored 24 hours a day. If the hazard is an emergency that requires immediate action please contact Campus Enforcement and Patrol at 709-637-2888 or 911.

System will timeout after 30 Minutes. Please complete report within that time.

General Information *

Time Reported

:

*

Creator Email

I want to receive a copy of this E-Alert in my e-mail

Location (Grenfell Campus)

Grenfell Campus

My Location is Not Listed

Location Not Listed (On Campus)

Is this a laboratory?

Yes

No

Is this a contractor?

Yes

No

MUN Safe Location (Admin Use Only)

General Information *

Individual Details - To be filled out for the individual that is completing this form.

I Wish to Remain Anonymous *

Yes

No

Name *

Position

Committee Name

If Other, Please Specify

Title

Department / Area of Study

Phone Number

Invalid phone number. Example: 123-459-7890

Description / Narrative

Incident Details / Description

Add any additional files that might be of use to the investigator using the attachment section of this report.

Location Description

Hazard Observation Details *

Hazard Observation: Source, situation, or act with a potential for harm in terms of human injury, illness, property damage, or a combination of these.

Hazard Observation Information

Type of Hazard *

Safety: Driving, Electrical, Forklifts, Ladders, Machinery, Material Handling, Platforms, Slips trips and falls, Tools, Leaks, Equipment malfunctions or breakdowns

Health: Biological (bacteria, mould, viruses, insects, plants, birds, animals, and humans), Diseases/disorders/injuries, Pandemics

Chemical: the physical, chemical and toxic properties of the chemical; includes asbestos, odours

Ergonomic: Lifting/pushing/pulling, Sitting/standing, Musculoskeletal Disorders, Lighting, Shiftwork, Office, Tools

Physical: Temperature, Indoor Air Quality, Noise, Radiation

Psychosocial: Stress, Violence/bullying, Mental Health

Cause of Hazard

Unsafe Act (Human)

Unsafe Condition (Environmental)

Unsafe Act (Human)

Other Unsafe Act, specify:

Unsafe Condition (Environmental)

Other Unsafe Condition, specify:

Corrective actions taken:

Please enter a brief description of events in the Narrative section for this report. Please try to include all pertinent details of the incident, but be as concise as possible

Attachment

Attach a new file

Attached Files

No Files Attached

* Required Fields.