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Health & Safety Hazard Reporting Form

Report should be submitted via this form or local campus safety representative or you may call 951-222-8566 to report to the District Safety & Manager

Norco College students, staff, faculty or visitors may use this form to report any unrecognized or uncontrolled safety issue to the Risk Management Department or their local College Safety Representative. The safety issue will then be investigated to determine if mitigations are needed. The form can be submitted anonymously if desired.

College / District Location Where Unsafe Conditions Exist: Norco College
Date Unsafe Condition Noticed:
Your Name: (Leave blank if you prefer to remain anonymous)
Your Phone Contact Information: (Leave blank if you prefer to remain anonymous)
Department: (Leave blank if you prefer to remain anonymous)
Your E-Mail Address: (Leave blank if you prefer to remain anonymous)
UNSAFE ACT DESCRIPTION or SAFETY HAZARD (Describe sequence of events. Provide all of the facts you can remember)
Suggestion for improving safety:
Has this matter been reported anyone on campus:

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