Safety Suggestion Sheet


Prepared by:                                    Date:                               

Department:                                  


Describe the potential safety hazard and what areas it could effect:                                      
                                                                                                                            
                                                                                                                            
                                                                                                                            

Recommendations or suggestions for eliminating or minimizing hazard:                               
                                                                                                                            
                                                                                                                           
                                                                                                                           

Department Manager:                                    

Disposition or Action Taken:                                                                                     
                                                                                                                           
                                                                                                                            
                                                                                                                           
                                                                                                                           




                                                                 
       Safety Manager                      Date