A Safety & Regulatory Compliance System

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Hazard Report

No.: New

Date Submitted:	07-02-25
Status:
Status Date:

SUBMITTER

First Name

Last Name

Telephone No. (optional)

Email Address (required if email turned on below)

DESCRIPTION

Description of Hazard

Attachments

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LOCATION OF HAZARD

Site

Building

Where in the Building

Accurately describe where the hazard is located at the site or where the unsafe activity occurred. If the location is not applicable to the hazard, enter "NA."

ASSIGNEE

OFFICE USE

Category

Account Code

Dept to which report should be sent

Environmental Health & Safety (EHS)

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