Report dangerous situation

Name *

Company name *

Telephone *

E-mail address *

Date *

Time *

Location *

Briefly describe the dangerous situation/abnormality *

Briefly describe the action you took immediately *

State what you think is needed to improve the situation *

Reported to (name of supervisor/responsible party) *

Send this form as a CC to * (maximum of 3 email addresses, comma-separated)

Attach photos of dangerous situation (1) Max file size: 8mb

Attach photos of dangerous situation (2) Max file size: 8mb

Attach photos of dangerous situation (3) Max file size: 8mb

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