Safety Concerns & Near-Misses
Use this form to report any general safety concerns and near-misses (a near-miss is an event that *could* have caused an accident, but didn't). DO NOT use this form to report an actual incident/accident.
Sign in to Google to save your progress. Learn more
Today's Date *
Your Name *
Who reported the concern? *
Location *
Description of Issue *
Suggestions how to eliminate the problem (optional)
Clear form
Never submit passwords through Google Forms.
This form was created inside of Innovative Facility Care Inc.. Report Abuse