Safety Suggestion Form Jan. 01, 2021 Please fill out the form to submit your suggestion. Description of potentially unsafe condition: Causes or contributing factors: Your suggestion for improving safety: Has this issue been reported to a Supervisor? Yes No If yes, please provide the Supervisor's name: Employee Name (Optional) Department Name: (Optional) Please enter a valid email address: (optional) Submit Thank you! Your Safety Suggestion has been submitted successfully!
