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HazardReport_Form
You can use this form to report, anonymously if you like, an unsafe condition or practice of which you have knowledge or have observed. We encourage you to report these situations to your supervisor, but if you have done that already this is another means of reporting. Please be specific in the information that you provide, such as: locations, descriptions of conditions or activities, and suggestions for correction.
HAZARD REPORTING FORM
This form is not to be used for emergencies or imminent danger situations. Please call 716-9111 for those types of emergencies.
Employee's Name:
Department:
Phone:
Email:
Unsafe Condition or Practice:
Location:
Suggestion for Correction:
Has this matter been reported to your supervisor?
Yes
No
Employees are advised that it would be illegal for an employer to take any action against an employee in reprisal for exercising rights to participate in reporting safety issues.