This form is used if at any worksite you face a situation, or an occurrence that you feel is a hazard to your working conditions.

A hazard is any practice, behaviour or condition or combination of these that can cause injury or illness in people or damage to property.

You may be asked to complete this form and submit it to your local office for them to follow-up with. In some circumstances you may also be required to report it to the onsite supervisor. Please contact your local office if you encounter any hazard for guidance on what to do, or if you have any questions.

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