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Campus Hazard Notification Form

Instructions

Fill out the appropriate sections of this form to send your report of a campus hazard situation to the UTA Police Department.

If the hazard represents a life-threatening situation, do not use this form. Call (817) 272-3003 immediately to contact the UTA Police Dispatcher, 24 hours a day. Use this form for:

  • physical security issues
  • hazardous materials concerns
  • health-safety concerns
  • areas that are in need of lighting
  • general safety concerns


Name: Date Reported:


Email: Phone #:


Building/Location Description:


Room/Office Number: Level of hazard:


Have you reported this previously? Yes No


Description of hazard:

I understand that my IP address will be submitted with this form to establish accountability in the event of harassing and/or fraudulent form submissions.



Thank you for your involvement in making the UTA Campus a safer place.