Health %26 Safety Committee Member Exit Form Template
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Health & Safety Committee Member Exit Form

Name

Position/Title

Department

Duration on Committee

Reason for Leaving

  • End of Term

  • Job Role Change

  • Resignation

  • Retirement

  • Other:                               

CONTRIBUTIONS AND EXPERIENCE

Please describe any significant contributions you have made to the Committee. What did you find most rewarding during your time on the Committee?

FEEDBACK ON COMMITTEE OPERATIONS

How effective do you believe the Committee is in promoting health and safety in the workplace? What improvements, if any, do you suggest for the Committee’s operation?

ACKNOWLEDGMENT

I confirm that the information provided in this form is accurate and reflects my experiences and opinions as a member of the Health & Safety Committee.

[Month Day, Year]

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