Health and Safety Complaint Form Template
save
save
copy
save
save
save
copy
copy

Health and Safety Complaint Form

Please fill out this form to submit your complaint.

Complainant Information

Name

    Department

      Phone number

        Email

          Complaint Details

          Date and Time of Incident

            Location of Incident

              Description of Health and Safety Issue

                Was Anyone Injured?

                Were Emergency Services Contacted?

                Have any corrective actions been taken?

                Supporting Evidence

                  Acknowledgment

                  I confirm that the information provided above is accurate and true to the best of my knowledge.

                  Date:

                  Complaint Form Templates @ Template.net