Environmental/Occupational Safety and Health

Safety Committee Improvement Suggestion Form

This Safety Improvement Suggestion form provides students, staff and faculty an opportunity to submit ideas to improve safety on campus, beyond the scope of legislated requirements. Submitted suggestions will receive a response from the campus safety committee.

Employees who wish to provide a safety suggestion or report an unsafe workplace condition or practice should do so using this form below:

  1. This safety suggestion system allows employees to point out safety issues (anonymously if desired). This proactive approach can catch many issues before they cause accidents. Suggestions and the resulting corrections can be tracked as a leading indicator in a total safety management program.
  2. An effective safety suggestion program not only asks employees to point out hazards, but also stimulates problem-solving thinking by having employees offer solutions.
  3. Employees must know their suggestions are valued. Communication throughout is vital. All employees must understand the procedures and time-lines from suggestion to implementation. Employees whose suggestions aren’t used must be given a reason why. The program must be fair, impartial, and non retaliatory.
  4. Upon completion of the form, click the 'Submit Suggestion' button. This will send the form to Joe Teff, Safety Administrator.

Select the safety hazard type (please check all that apply):

Physical Hazards

Radiation

Confined Space

Heat/Cold

Noise

Vibration

Slips/Trips/Falls

Struck by/Against

Sharps/Cuts

Chemical/Biological Hazards

Bio-hazardous material

Asbestos

Compressed gas

Dust/Fumes/Vapors

Chemicals

Hazardous materials

Fire/Explosion

Human Factor Hazards

Preventative Ergonomic (repetition, posture, manual lifting, pushing, pulling)

Visibility

Working Alone

Driving

Other types

Other

Suggestions

Safety improvement recommendation(s):

Suggested steps necessary to implement the recommendation:

Approximate cost (if applicable)

Is there a cost with your suggestion? (amount)

Applicability in other departments? 

If YES, please list departments here:

Your name, phone number, and e-mail address are optional. However, providing them will enable our safety and health committee to seek clarification regarding your suggestion and respond to you.