* Use this form to report a hazard that may require follow-up from your supervisor.
* Staff to submit this form as soon as possible.
* The supervisor will conduct the investigation.
* A copy of this form will be routed to the Division Health & Safety Officer and WSH CoChairs who will route it as appropriate.
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This form is to be used for hazard identification only. This does not replace a Near Miss (something happened that could have caused injury, but didn't) or an Incident Report (an injury occured).