Safety Suggestions Form

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Safety Suggestions
Department:
Location:
Date:
Category
Potential severity
Environmental
Low
Injury/Illness
Moderate
Property Damage
Severe
Vehicle
Other ________________
Your Safety Suggestion:
Your Name (optional):
Please attach photos, diagrams, or drawings to help illustrate your ideas.
This form can be printed and sent to . Alternatively, call, text, or visit with me in person.

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