Generator Incident Report
For all medical emergencies please call 911.
Generator's top priority is member safety and security. Thank you for taking the time to report an incident so that we can address it.
Filling out this form sends an email alert to multiple staff members. A staff member will follow-up with you as soon as possible, usually within 1-3 business days.
If an incident requires immediate assistance, please call Christine on her cell phone at (339) 223-0722.
Your Full Name
Date of incident
Time of incident
What kind of incident are you reporting?
Injury (Please describe if injury required medical attention or shed blood)
Verbal conflict or disagreement
Unsafe member activity
Broken tool or equipment
Questionable member status and/or tool certification
Please describe the incident.
Do you have a suggested action? If so, please describe it.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of generatorvt.com.