Unsafe Equipment Warning Form
Report unsafe equipment conditions to help ensure workplace safety. Please provide detailed and accurate information.
Your Full Name
*
First Name
Last Name
Department or Team
*
Contact Email or Phone Number
*
Equipment Name or ID
*
Equipment Location
*
Equipment Type or Category
*
Please Select
Mechanical
Electrical
Chemical
Personal Protective Equipment
Tools
Other
Severity of Hazard
*
Please Select
Low
Moderate
High
Critical
Detailed Description of Unsafe Condition
*
Has the equipment been taken out of service?
*
Yes
No
Immediate Action Taken or Recommended
Submit Report
Should be Empty: