Environmental or Occupational Safety Concern/Inquiry

If you wish to report a safety issue or ask a safety question such as, purchasing or proper disposal of chemicals, safety training for OSHA and EPA topics, questions about personal protective equipment selection, please fill out the information requested below as thoroughly as possible.

DO NOT use this form for reporting injuries and illnesses. All injuries and illnesses including Worker’s Compensation related reports must be reported to Public Safety at the appropriate campus. If you need assistance with the form, you may contact Environmental Safety at environmentalsafety@montgomerycollege.edu.

Your name *This question is required.

Email address *This question is required.

Phone number *This question is required.

Your affiliation with Montgomery College *This question is required.

Your Location *This question is required.

Building/Room number *This question is required.

Subject of Concern/Inquiry *This question is required.

Description of Concern/Inquiry *This question is required. Provide details about location, description of conditions, quantity, type of material or hazard, chemical name, manufacturer etc.