Job Hazard or Close Call Assessment
This form is forwarded to the Safety Department for investigation. Thank you for your report this helps us grow in safety culture.
Information on how to complete the form
Area Information
Job Number
Geolocation
*
Address of the Hazard Reported
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Temperature
Describe the Hazard or Close Call
Recommendations on how we reduce or eliminate this hazard in the future?
Reported by and contact number:
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Submit
Should be Empty: