Staff Safety Report

Safety starts with you! Thank you for taking the time to helping keep Powderhorn safe.

Name

Who is completing this form? (May be completed anonymously)

First Last

What are you reporting?(Required)

Recognizing an employee for putting safety first

Reporting an unsafe condition

Reporting a near miss

Where did the event occur?(Required)

What happened during the event?(Required)

Who was involved?

How could this event have been prevented?(Required)