"Campus Safety Suggestion Form - Safe First"

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CAMPUS SAFETY
No:
SUGGESTION FORM
INSTRUCTIONS
Suggested by:
Please type or print any suggestions/concerns that
may improve campus safety and prevent illnesses
Signature:
or injuries from occurring. This from is for non-
emergency issues and should be given to your
Safety Committee Representative, Supervisor, or
Date:
Department:
Physical Plant. The safety Committee will review
*Name not mandatory unless direct response is requested.
and respond accordingly.
Written Response form
DESCRIPTION OF SAFETY ISSUE:
YOUR SUGGESTED SOLUTION:
safety Committee
Requested?
Yes
No
ACTION TAKEN
Initially Received by:
Date:
Safety Committee Review Date:
CAMPUS SAFETY
No:
SUGGESTION FORM
INSTRUCTIONS
Suggested by:
Please type or print any suggestions/concerns that
may improve campus safety and prevent illnesses
Signature:
or injuries from occurring. This from is for non-
emergency issues and should be given to your
Safety Committee Representative, Supervisor, or
Date:
Department:
Physical Plant. The safety Committee will review
*Name not mandatory unless direct response is requested.
and respond accordingly.
Written Response form
DESCRIPTION OF SAFETY ISSUE:
YOUR SUGGESTED SOLUTION:
safety Committee
Requested?
Yes
No
ACTION TAKEN
Initially Received by:
Date:
Safety Committee Review Date: