Get Safety Concern Form

The Safety Concern Form is an essential tool for reporting health and safety concerns or near miss incidents in the workplace. This guide provides clear, step-by-step instructions on how to effectively complete the form online, ensuring that your concerns are communicated efficiently.

Follow the steps to accurately complete the Safety Concern Form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the worker’s name in the designated field to ensure proper identification.
3. Specify the worker’s union affiliation to provide context regarding representation.
4. Record the date this form is being submitted to the supervisor to establish a timeline.
5. Fill in the work site where the concern or near miss incident occurred, ensuring it is accurate.
6. Write down the supervisor’s name in the corresponding field to identify the individual responsible for the response.
7. In the section labeled 'The Worker’s Concern,' provide a detailed description of the concern or near miss incident, including background information and any suggestions for resolution.
8. Remember to retain a copy of this section before submitting it, as it may be needed for your records.
9. If necessary, attach additional pages to elaborate further on the concern.
10. Upon completion, submit the form to your immediate supervisor. Ensure they receive it for their action.
11. The supervisor will record the date they received the form and respond within five business days.
12. Once the supervisor responds, enter the date of their response and the date you received it.
13. Finally, the supervisor should sign the form, confirming their acknowledgment and action taken.
14. You may now save changes, download a copy, print it for your records, or share it as needed.

Complete the Safety Concern Form online to ensure your health and safety concerns are addressed promptly.