Get Da Form 4755

Filling out the Da Form 4755 online can streamline the process of reporting unsafe or unhealthful working conditions. This guide provides a step-by-step approach to help users complete the form efficiently and accurately.

Follow the steps to fill out the Da Form 4755 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting who is submitting the report by checking the appropriate box: Employee, Representative of employees, or Other (please specify).
3. Indicate whether the hazard immediately threatens serious physical harm by checking 'Yes' or 'No.' If 'Yes' is selected, it is advised to immediately contact your supervisor or safety representative.
4. Provide your contact information, including your telephone number, and the name of the official in charge, along with the operation/activity and the exact location of the worksite.
5. Detail the kind of operation being performed at the worksite and briefly describe the existing hazard, including the number of employees exposed to this hazard.
6. If applicable, list any occupational safety and health standards that may have been violated.
7. Include information on any past grievances related to the hazard, including whether the hazard was discussed with the employer or their representative, and summarize any management's efforts to address the hazard.
8. Express your preference regarding anonymity by selecting if you do not want your name revealed to the official in charge or if you permit your name to be shared.
9. Print or type your name, telephone number, and the date, followed by your signature to verify the report.
10. Finally, review all entries for accuracy before saving changes, downloading, printing, or sharing the form.

Start completing your Da Form 4755 online today for a safe working environment.