Safety Concern Reporting Form - Electrical Engineering 2026

1. Click ‘Get Form’ to open the Safety Concern Reporting Form in the editor.
2. Begin by filling out Part A – Safety Concern. Enter your name and contact number in the designated fields to identify yourself as the reporter.
3. Next, provide the name of your supervisor and a detailed description of the safety concern or hazard you observed, including the date it was observed.
4. Specify the building and exact location where the issue was noted. Use the text box provided to elaborate on the nature of the safety concern.
5. Finally, write a recommendation for remedying the safety concern in the space provided. This will help ensure that appropriate actions can be taken.
6. Once completed, review your entries for accuracy before submitting. You can easily email the form directly from our platform to Dave DeCapria at dwd2@psu.edu.

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