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:          

Phone:     

E-mail:     

Department:     

Unsafe Condition or Practice:       

Location:       

Suggestion for Correction:     

Has this matter been reported to your supervisor?

 

 

 

 

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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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