Safety Concerns are anything of concern that may result in an accident or injury if left unaddressed, including unsafe equipment, work practices, environments, etc. 

Near misses are situations that almost result in injury, accident, or major property damage, but an action is typically taken to prevent the incident. 

Access the SCAN form in Spanish

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Department:

*Building/Area:

Room Number:

*Date of Concern:

Time of Concern:

Select the time you noticed the SCAN.

*Your Designation:

Faculty

Staff

Student

Student Worker

Visitor

Prefer Not to Disclose

*Concern Type(s):

Near-Miss (almost accident)

Unsafe Act

Unsafe Condition

Unsafe Equipment

Unsafe Work Practices

Unsafe Environment

Security Concern

Authoritative Abuse (for example, being asked to perform unsafe actions)

Select all that apply to the SCAN you witnessed.

*Describe your concern(s):

Please provide an account of your concern(s), include as much detail as possible. Remember SCANs are confidential.

Your Name:

Submissions may be anonymous; however, all SCANs are confidential and no repercussions will proceed. Your contact information is important to following up on submitted reports.

Your Contact Information:

Submissions may be anonymous; however, all SCANs are confidential and no repercussions will proceed. Your contact information is required if you request a follow up report.

I wish to receive a follow up report on my SCAN submission

Yes

No

If you select yes, you must provide an email address above for follow up reporting.

*I will upload an image below.

Yes

No

Please check yes or no.

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You can attach an image to your SCAN report. Upload your image file using the Microsoft Forms insert below and click "Submit" prior to submitting your SCAN report above. You can also email them to safety@ttu.edu. Submitting photos requires submission of your name and email address. But do not worry! Your identity is always protected.

How to Complete the SCAN FormRequest SCAN cards 

Laminated, two-sided cards with or without slot for lanyards. Submit request with quantity and type.