LAX Safety Reporting Form

LAX Safety Reporting Form
Thank you for taking the time anonymously report a safety hazard, safety concern and/or health concern, Please know that all information you provide will be kept strictly confidential and if names are provided, they will not be shared.

When submitting your concern, include as much detail as possible to help us investigate thoroughly.

A TWU Local 575 Safety Committee member will review the information you provide and follow up with you regarding this concern.

Important: Please notify your On-Duty Manager (MOD) and a Union Representative/Safety Team member right away.

The Safety Committee takes every report seriously and is committed to investigating all concerns to protect our membership.
Select Report Type
Location
Location: Other
*Only Complete this section if location is not above*
Date of Safety Incident

MonthDayYear
Date
Hour Minutes
What is this report about?
When submitting your concern, include as much detail as possible to help us investigate thoroughly: • Who was involved • What happened • When it occurred • Where it took place • Why it may have happened (if known) • How it occurred
Has this been reported to Management?
If Yes, Which Manager?
Add Photos or Videos: (Attach pictures, if available)

Cancelof
Full Name

First NameLast Name
Employee ID Number
Personal Email (No Company/AA Email)
example@example.com
Should be Empty: