Headed titled Report a Safety Concern

Safety Concern Form

This form is for use by employees who wish to provide a safety suggestion or report an unsafe work place condition or practice.  Anonymous suggestions are always welcome.

Employees are advised that use of this form or other reports of unsafe conditions or practices are protected by law. It is illegal for an employer to take any action  against an employee in reprisal for exercising his/her right to participate in communications involving safety hazards.

CSUSM will investigate all reports of unsafe conditions as required by the Injury and Illness Prevention Program Standard (8 CCR 3203) and advise the employee who provided the information or the workers in the affected area.

Please complete the following:

Please enter your full name or leave blank if anonymous

Please enter your department or leave blank if anonymous

Please enter your phone number/extension or leave blank if anonymous
*
Please enter your email or leave blank if anonymous
*

Please enter the description of the problem or suggestion which you are submitting

Please enter your suggesting to improving the problem which you are submitting

Submit