Unsafe Working Conditions Report

Unsafe Working Conditions Report - New Item

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Date

If you observe a situation that you believe is an unsafe working condition, please complete and submit this form. We appreciate that you care about your co-workers and the people we support and will never discriminate against you for completing an unsafe working conditions report. If the concern is of an urgent nature, please contact your supervisor or HR directly.

Describe unsafe situation

Describe the unsafe situation you observed (date, time, people present, equipment in use,
environmental factors, etc.)

Location

Location / address where unsafe working condition was observed

Potential risks

What are the potential risks of this situation?

Improvements

What improvements can be made to ensure a safe work environment?

Your name

Your phone number

Please provide your name and phone number so we can follow up with you.

Thank you for raising this concern. It is our intention to provide a safe living and working
environment for the people we support and our employees. We will respond to this report as soon as possible. Our Health and Safety committee meets monthly and reviews these reports and our responses.

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