Safety Concerns and Near Misses

Near misses are potential hazards or incidents that have not resulted in any personal injury or property damage. Examples include unsafe conditions, unsafe work habits, improper use of equipment, use of malfunctioning equipment, or unexpected reactions. It is everyone’s responsibility to report and correct these potential hazards immediately. Please complete this form as a means to report these situations and help prevent future incidents at Michigan Tech.

For questions or cases deemed immediately dangerous to life or health, call EHS at 906-487-2118. In the case of an emergency, call 911 immediately.

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Department

Building/Area *

Room Number

Date of Concern *

Time of Concern *

Designation *

Faculty

Staff

Student

Student Worker

Prefer Not to Disclose

Other Designation(s)

Concern Type *

Unsafe Act

Unsafe Condition

Unsafe Equipment

Unsafe Practices

Description of Issue(s) *

Name

Contact Information

If you have a photo(s) to help demonstrate your safety concerns, please email them to safety@mtu.edu. Please use the subject "Safety Concern." If you are reporting a past concern, please include the date that the photo was taken. Thank you for your assistance.

Red box with white text of Emergency: Dial 911.