Fillable CITY OF DANBURY HAZARD REPORT Safety is the (City of Danbury)

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CITY OF DANBURY HAZARD REPORT Safety is the (City of Danbury)

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Location: Date: Time:
Reported by: Signature: Date:
Signature:
Date:
HAZARD REPORT
CITY OF DANBURY
Safety is the responsibility of each and every employee of the City of Danbury!
Part I - To Be Completed by Employee Reporting Unsafe Act or Condition :
How long has Condition Existed?
Description of Unsafe Act or Condition
Safety Suggestion
Dept Reported to:
Part II - To Be Completed by Department Supervisor Responsible for Correction
Rev. 08/04
Forward a copy to the Building Supervisor or Manager, Department Supervisor responsible for correction, and Risk Management upon completing Part I.
Action Taken: (be specific, i.e.: new equipment, retraining, etc.)
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CITY OF DANBURY HAZARD REPORT Safety is the (City of Danbury)

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Completed 18 January 2021

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