{"id":1468,"date":"2022-03-07T00:46:48","date_gmt":"2022-03-07T04:46:48","guid":{"rendered":"https:\/\/www.umes.edu\/ehs\/?page_id=1468"},"modified":"2026-07-28T11:26:39","modified_gmt":"2026-07-28T15:26:39","slug":"research-registration","status":"publish","type":"page","link":"https:\/\/www.umes.edu\/ehs\/research-registration\/","title":{"rendered":"Reporting University&#8217;s Incidents, Near-Misses, and Safety Concerns."},"content":{"rendered":"\n<p class=\"has-medium-font-size wp-block-paragraph\">Use our online form to report any safety concerns you have, including near-misses, incidents that have occurred, unsafe conditions\/equipment\/work habits or any other safety or compliance issues. These may be near-misses, incidents that have occurred, unsafe work conditions, compliance issues, or any other safety concern you may have. <\/p>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\">Do not use this form to report criminal activity, please contact Public Safety at 410-651-3300.<\/p>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\">If your report includes unsafe building condition(s) or problem(s) with the building infrastructure, please submit a Work Order through the Physical Plant as well.<\/p>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\">If your report includes a workplace injury(s), please submit a report to Human Resources as well.<\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1817 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1817\" data-uid=\"6a89147f08af6\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-1817\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1817 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"1817\"\r\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a89147f08af6\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a89147f08af6\" id=\"forminator-field-name-1_6a89147f08af6-label\" class=\"forminator-label\">Name (If wish to remain anonymous, put anonymous)<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a89147f08af6\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a89147f08af6\" id=\"forminator-field-name-2_6a89147f08af6-label\" class=\"forminator-label\">Contact Information (Provide preferred method of contact if you would like EHS to follow up with you)<\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6a89147f08af6\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Email of people who need to receive report<\/label><span class=\"forminator-description forminator-repeater-description\">(i.e. Supervisor&#8217;s, P.I.s, Directors)<\/span><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a89147f08af6\" id=\"forminator-field-email-2_6a89147f08af6-label\" class=\"forminator-label\">Email Address<\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a89147f08af6\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a89147f08af6\" id=\"forminator-field-name-3_6a89147f08af6-label\" class=\"forminator-label\">Location of safety issue [Include building\/Area and Room number, if applicable]. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_6a89147f08af6\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6a89147f08af6\" id=\"forminator-field-name-4_6a89147f08af6-label\" class=\"forminator-label\">Date of Concern [month, day, year] <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6a89147f08af6\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_6a89147f08af6\" id=\"forminator-field-name-5_6a89147f08af6-label\" class=\"forminator-label\">Time of concern [please specify a.m.\/p.m]<\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"\" id=\"forminator-field-name-5_6a89147f08af6\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1817__field--select-1_6a89147f08af6\" id=\"forminator-form-1817__field--select-1_6a89147f08af6-label\" class=\"forminator-label\">Report Type <span class=\"forminator-required\">*<\/span><\/label><select multiple id=\"forminator-form-1817__field--select-1_6a89147f08af6\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1[]\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select an option\" data-search=\"false\" data-search-placeholder=\"Search\" data-checkbox=\"false\" data-allow-clear=\"true\" aria-labelledby=\"forminator-form-1817__field--select-1_6a89147f08af6-label\"><option value=\"one\"  data-calculation=\"0\">Incident (event resulted in injury or property damage occured)<\/option><option value=\"two\"  data-calculation=\"0\">Near-Miss (event had the potential for loss, though no injury or damage occured<\/option><option value=\"Safety-Concern\"  data-calculation=\"0\">Safety Concern<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a89147f08af6\" id=\"forminator-field-textarea-1_6a89147f08af6-label\" class=\"forminator-label\">Description of Issue(s) <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a89147f08af6\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\" style=\"margin: 0;\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6LcCCBQdAAAAAP73y91aYkTmlJsRh0SvZzWKMuhk\" data-size=\"invisible\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"3710389d2b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ehs\/wp-json\/wp\/v2\/pages\/1468\" \/><input type=\"hidden\" name=\"form_id\" value=\"1817\"><input type=\"hidden\" name=\"page_id\" value=\"1468\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.umes.edu\/ehs\/research-registration\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_10\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_10\" type=\"text\" name=\"input_10\" value=\"\" autocomplete=\"off\"><\/label><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Use our online form to report any safety concerns you have, including near-misses, incidents that have occurred, unsafe conditions\/equipment\/work habits or any other safety or compliance issues. These may be near-misses, incidents that have occurred, unsafe work conditions, compliance issues, or any other safety concern you may have. Do not use this form to report&#8230;<span class=\"cpschool-read-more-link-holder\"><a class=\"btn btn-basic cpschool-read-more-link\" href=\"https:\/\/www.umes.edu\/ehs\/research-registration\/\">Read more <span class=\"sr-only\">Reporting University&#8217;s Incidents, Near-Misses, and Safety Concerns.<\/span><\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","footnotes":""},"folder":[],"class_list":["post-1468","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/pages\/1468","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/comments?post=1468"}],"version-history":[{"count":0,"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/pages\/1468\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/media?parent=1468"}],"wp:term":[{"taxonomy":"folder","embeddable":true,"href":"https:\/\/www.umes.edu\/ehs\/wp-json\/wp\/v2\/folder?post=1468"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}