Report • CampusOptics

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Name* Required

Additional Location Details

Exact Location

Loading…

What is your job title?

What is the activity or process your analyzing?

How many steps are involved in the activity or process?

What is the first step?

What is the second step?

What is the third step?

What is the fourth step?

What is the fifth step?

What is the last step?

What are the hazards and consequences in performing the activity in your first step?

What are the hazards and consequences in performing the activity in your second step?

What are the hazards and consequences in performing the activity in your third step?

What are the hazards and consequences in performing the activity in your fourth step?

What are the hazards and consequences in performing the activity in your fifth step?

What are the hazards and consequences in performing the activity in your last step?

What are the controls or safeguards in your first step?

What are the controls or safeguards in your second step?

What are the controls or safeguards in your third step?

What are the controls or safeguards in your fourth step?

What are the controls or safeguards in your fifth step?

What are the controls or safeguards in your last step?

Specify the training required to perform the activity or process.

What is the required PPE you anticipate using for the activity or process?

List all the individuals conducting this activity or process. Specify their job title in parenthesis.

Certification Statement - Pending Approval

Add files to upload as supporting documentation along with your incident.