Free Workplace Safety Complaint Form

Please fill out this form to submit your complaint.
Employee Information
Name
Employee ID
Department
Job Title
Phone number
Incident Details
Date of Incident
Location of Incident
Description of the Safety Concern/Incident
Type of Safety Issue
Slip/Trip/Fall Hazard
Fire Hazard
Chemical Exposure
Electrical Hazard
Machinery/Equipment Issue
Poor Ergonomics
Personal Protective Equipment (PPE) Issues
Have you reported this issue to your supervisor?
Acknowledgement and Signature
I acknowledge that the information provided in this complaint is true to the best of my knowledge. I understand that any false reporting or retaliation against the individual filing the complaint will not be tolerated.
Date:
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Ensure a safe work environment with our Workplace Safety Complaint Form Template. Designed for easy use and quick submission, this template helps employees report safety concerns efficiently. With the added convenience of the AI Editor Tool, you can personalize the form to suit your needs, ensuring accurate documentation and timely resolution of safety issues. Keep your workplace compliant and safe today!