Get Da 4755

The DA 4755 form is a crucial document for reporting alleged unsafe or unhealthful working conditions. This guide provides clear instructions on how to accurately complete the form online to ensure your concerns are effectively communicated.

Follow the steps to accurately complete the DA 4755 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate whether you are an employee, representative of employees, or another type of complainant by checking the appropriate box.
3. State the job safety or health hazard you believe exists at your place of employment by providing the exact location of the worksite.
4. Answer the question about whether the hazard immediately threatens serious physical harm. If 'yes', make sure to contact your supervisor or safety representative.
5. Provide your contact information, including telephone number and the name of the official in charge of operations or activities.
6. Describe the nature of the operation and briefly detail the hazard, including how many employees are exposed to or threatened by this hazard.
7. List any safety and health standards that may have been violated, if you are aware of any.
8. Indicate whether this hazard has been previously addressed through union/management grievance discussions, and summarize any outcomes, if applicable.
9. Select your preference regarding confidentiality by checking either to remain anonymous or to have your name revealed to the official in charge.
10. Type or print your name as the person submitting the report, add your telephone number, date of submission, and provide your signature.
11. Review the completed form for accuracy, then save changes, download, print, or share the form as needed.

Complete your DA 4755 form online today to ensure your safety concerns are addressed.