Please enable javascript in your browser to view this site!

Report Safety Concern or Incident

This form is for employee's who wish to report a safety concern or a incident that has happened to you or a fellow coworker.

 
 
Your name
Your name
Optional, but recommended for assisting in investigations
Type of report *
Safety hazard - are unsafe working conditions that that can cause injury, illness, and death. Biological hazard - include exposure to harm or disease associated with working with people. Physical hazard - can be any factors within the environment that can harm the body without necessarily touching it. Electrical hazard - have a risk of injury or death from electric shock or poses as a fire risk. Ergonomic hazard - occur when the type of work, body positions and working conditions put a strain on your body. Chemical hazard - are present when a worker is exposed to any chemical preparation in the workplace in any form. Work Organization hazard - are associated with workplace issues such as workload, lack of control, and/or respect,
Separate names with a comma ","
Name of witness
Date and time of concern or incident
Date
Date