CalPoly
Risk Management

 

Risk Management
Environmental Health & Safety
Cal Poly State University
San Luis Obispo CA 93407
Telephone: (805) 756-6662

REPORT OF HAZARDOUS CONDITION

Cal Poly State University

Risk Management
Environmental Health &
Safety

Use this form to submit a report of a hazardous condtion or safety concern in your workplace or anywhere on campus.

Enter your Name:

Enter your Department:

Enter your Extension    

E-mail Address

Location of the Hazardous Condition You Wish to Report
(Please be as specific as possible, include building and room numbers,
if applicable):


Description of the Hazardous Condition You Wish to Report
(Please be as specific as possible, including descriptions of
equipment or processes involved if applicable):




 

Questions or comments regarding this page should be e-mailed to David Ragsdale, Environmental Health and Safety Manager, Cal Poly Risk Management.

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This page last updated May 16, 2001.