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This form is for use by employees who wish to report an unsafe workplace condition or practice. Employees are advised that the use of this form or other reports of unsafe conditions or practices are protected by law. It would be illegal for the employer to take any action against an employee in reprisal for exercising rights to participate in communications involving safety. Environmental and Occupational Safety will investigate any report or question and advise the employee who provided the information or the workers in the area of the response.

If you wish to remain anonymous, leave the name field blank. All information provided on this form will be reviewed by the Director of Environmental and Occupational Safety.