Safety Concerns

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Safety Concern

* Required

1. First Name *

2. Last Name *

3. Area of concern *

4. Line of concern *

5. Machine of concern *

6. Date of occurrence *

7. Did a physical incident happen? *

Yes

8. Description of unsafe condition / incident (Give as much detail as possible) *

9. Has the unsafe condition been corrected? *

Yes

10. Trade responsible for correction? *

11. Upload Image(s) / Attachment(s) (optional)