University Safety Hazard Report Page 2
ADVERTISEMENT
1
2INVESTIGATION OF HAZARD
IMMEDIATE ACTION TAKEN
FOLLOW-UP ACTION TAKEN
PERSON CONTACTED:
DATE:
TIME:
REMARKS:
NEW ESTIMATED COMPLETION DATE:
PERSON CONTACTED:
DATE:
TIME:
REMARKS:
NEW ESTIMATED COMPLETION DATE:
SUMMARY OF INVESTIGATION:
ACKNOWLEDGMENT
I certify that I have investigated the hazards reported in this hazard report and will take the necessary steps to ensure
correction of safety deficiencies noted.
* Further detailed on attachment:
Yes
No
Name:
Signature:
Title:
Date:
Time:
REPORT FORM RETENTION INFORMATION
ATTACHMENTS
Permanent Retention File:
Location:
*Yes
No
Date Filed:
Filed By:
*See Following Pages
Accident/Hazard Investigation Program
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cms-2786x - Fire Safety Survey Report - Icf-iid (apartment House) 2012 Life Safety Code
Medical
Form Cms-2786w - Fire Safety Survey Report - Icf-iid (large Facilities) 2012 Life Safety Code
Medical
Related Categories
Parent category: Business