Students’ Union Hazard Reporting Form

Students' Union Hazard Reporting Form

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Employee Name:

Campus: *

Location of Hazard: *

Description of Hazard

Date of Identification: *

Feedback Response Form

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Please select a topic * Please select a topic

Please leave your feedback here. *

If your feedback is in regards to the Undergraduate Health & Dental Plan, please include your Student ID #

Would you like a response to your feedback? *

Yes

Email address *

The Students' Union reserves the right to only respond to emails sent from @mylaurier.ca and @wlu.ca emails

Which Campus do you study on? *

Waterloo

Brantford

Not Applicable

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