Hazard Report Form - The Ohio State University

The Ohio State University Airport Safety Management Systems
HAZARD REPORTING FORM
Employees, users, and associated organizations of The Ohio State University Airport are
encouraged to use this form to submit safety hazards that may have been observed or
encountered. Information collected on these hazards will be used to determine trends and
hotspots that could be potential safety risks. The form can be submitted anonymously, if
desired. The system is designed to be non-punitive, and the information collected will
remain internal. Please complete the form and submit via the provided envelope..
Date/Time of Observation: ________________________________________________
Reported By (optional): ________________________________________________
Dept./Org. (optional): ________________________________________________
Location Description: ________________________________________________
________________________________________________
Location on Crash Grid: ________________________________________________
(refer to back of form)
HAZARD DESCRIPTION
Please Check One
Wildlife Incursion [ ]
Aircraft Incursion [ ]
Ground Vehicle/Pedestrian Incursion [ ]
Ramp Safety [ ]
Other [ ]
Objects Involved: ________________________________________________
________________________________________________
Persons Involved: ________________________________________________
________________________________________________
Wildlife Involved: ________________________________________________
________________________________________________
Description: ________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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