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Safety Concern Form
Department of Environmental and Occupational Health and Safety
Today鈥檚 Date:
Contact Information
First Name: *
Last Name: *
Email address: *
Building: *
Please select a building
122 South College (Trecaso's)
32 South College (Superior Auto Service)
Administrative Services Building(Goodwill)
Athletics Field House
Auburn Science & Engineering Ctr.
Ayer Hall
Ballet Center
Bath Nature Preserve
Bierce Library
Broadway Bldg. (Foundation)
Buchtel Field Svc. Bldg.
Buchtel Hall
Buckingham Building
Bulger Hall
Business Admin. Bldg.
Carriage House
Carroll Street Building (Sigma Nu)
Center For Child Development
College of Arts and Sciences
Computer Center
Crouse Hall
Electric Substation
Exchange Parking Deck
Exchange Street Residence Hall
Express Building
Folk Hall
Forge St. Substation
Gallucci Hall (N)
Gallucci Hall (S)
Garson Hall (Foundation )
Gas Turbine Testing Facility
Goodyear Polymer Ctr.
Grant B-1
Grant C-1
Grant High Rise
Grounds Maintenance Bldg.
Guzzetta Hall
Haz. Mat. Stor, Bldg.
Honors Center
Honors Residence Hall
Hower House
Info Cision Stadium/Summa Field
Jackson Field Storage Bldg.
James A. Rhodes Health & P.E. Bldg.
Knight Chemical Lab.
Kolbe Hall
Leigh Hall
Lincoln Bldg.
Martin University Center
Mary Gladwin Hall
McDowell Law Center
Medina County University Center
Memorial Hall
National Polymer Innovation Center
Ocasek Natatorium
Olin Hall
Olson Research Center
Orr Resident Hall
OTT Building
Parking Deck, East
Parking Deck, North
Physical Fac. Operations Ctr.
Polsky Building
Polymer Eng. Academic Center
Polymer Training Center (Foundation)
Quaker Square
Ritchie Hall
Roadway Building
Robertson Hall
Rubber Bowl
Schrank Hall (North)
Schrank Hall (South)
Simmons Hall (Student Affairs Building)
Sisler-McFawn
South Campus Parking Deck
Spanton Hall
Spicer Residence Hall
Stitzlein Alumni Assoc. Center
Student Recreation and Wellness Center
Student Union
The C.P. and Cornelia Chima Family Building
Thomas Performing Arts Hall
Wayne College & Boyer H.P.E. Bldg.
Wayne College @ Holmes County Higher Ed Ctr
Wayne College Classroom Bldg. (Trailer #1)
Wayne College Classroom Bldg. (Trailer #2)
Wayne College Maint. Bldg.
West Campus Parking Deck
West Hall
Whitby Hall
Zook Hall
Room Number: *
Department: *
Supervisor: *
Concern Information
Location of Concern: *
Reason for Concern: *
Maximum of 1000 characters
Did an accident occur? *
Yes
No
If yes, provide date and time:
Date:
Time:
a.m.
p.m.
Was an accident report filed with University Police? *
Yes
No
Was a departmental accident/incident report filed? *
Yes
No
An asterisk (*) denotes a required field