HAZARD REPORTING FORM

THIS IS A HAZARD REPORTING FORM FOR INTERNAL USE ONLY BY CITY EMPLOYEES.
The goal of this reporting system is to eliminate hazards in our city. All reported hazards will be forwarded to the appropriate department. A Hazard Reporting Example - A firefighter out on a call of a citizen who fell and was injured. The firefighter notices the sidewalk, which caused the injury, needs repair. They use this Hazard Reporting System to notify the Risk Management of their concern. All reported hazards will be forwarded on to the appropriate department. Please feel free to call Risk Management with any questions. Thank you.  

Type of Hazard, Location and Date noticed:
 
Description of Hazard:
 
Please provide any other helpful comments:
 
OPTIONAL:
Name:
Department: