PSC-CUNY Health and Safety
Incident Report
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O
Indoor Air Quality / Dust |
O
Heating/Air conditioning/temperature O Other ________________________
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Campus: ______________________________________________________________
Date reporting problem: ___________________________________________________
Person /group reporting: __________________________________________________
Phones:________________________________________________________
Email: _____________________________________________________________
Nature of Complaint:
Dates of occurrence: ________________
Location: (building, floor, room etc.) ________________________________________________________________________
Description of problem: ______________________________________________________________________________
______________________________________________________________________________
How many people affected? _________________________
Health problems? ________________________________________________________
Were Administrative personnel informed about complaint? Yes___ No____
Who and when? _____________________________________________
How informed? (phone, email, memo) _________________________________________
Please forward to
PSC/CUNY Environmental Health and Safety Watchdog Committee
61 Broadway 16th floor
New York, New York
212-354-1252/ fax: 212 302-7815
email:
hswatchdogs@pscmail.org
Interested in working with the Environmental H&S Watchdogs at Brooklyn College?
Contact Joan Greenbaum/Jean Grassman Co-chairs at
hswatchdogs@pscmail.org
UPDATED 3/19/10