LLU Complaint Form
Asterisks (*) indicate required fields Help is available by clicking on the highlighted field label
NOTE: IF YOU ARE REPORTING AN EMERGENCY, PLEASE DO NOT USE THIS FORM!
CALL SCC (Security Control Center) @ EXT. 911 TO REPORT AN EMERGENCY
Complainant Information
Your Name*
Do you want to remain anonymous?*
Yes No
Do you want a response from EH&S?*
Yes No
Your Department/Unit*
Your Building of Employment*
Lookup
Your Work Phone*Ext (if available)
Alternate Phone (Cell, home, etc)
Email (if available)
Hazard/Complaint Information
Date*
Time (if available)
x
Location (be as specific as possible)*
Type*
Description*
Submit