Safety Observation Report
Salazar Service uses this form to gather any report(s) of unsafe behavior(s), for the purposes of correction, analysis, and prevention.
Do You wish to Stay Anonymous(Unknown) for the purposes of Reporting? *
Reported By: Optional
Date of Observation: *
MM
/
DD
/
YYYY
Time of Observation: *
Time
:
Area, Location, Address or Road/Intersection of Observation: *
Describe Who or What company/organization You Observed? *
Describe What Unsafe Act(s) You Observed: *
Do you have any pictures or files that you would like to upload?
Did this involve a Vehicle on the Road? *
If a Vehicle was involved, do you have a Unit #,PKU #, or License Plate #?
Did you take any corrective action toward the unsafe behavior or confront the individual(s) involved? *
Describe any corrective actions on your part if taken:
Would you like to leave Your Name, phone, or email address for any possible updates or resolutions?
Submit
Never submit passwords through Google Forms.
This form was created inside of Salazar Service & Trucking Corp.. - Terms of Service - Additional Terms