HomeMy WebLinkAboutINCIDENT REPORTING AND SUGGESTION FORMS
Forms
Accident/Incident Report
Confidential Hazard Reporting Form
C I T Y O F A T A S C A D E R O
Anonymous and Confidential Hazardous
Conditions Reporting Form
This form is to be used by City employees to report unsafe conditions. It is for the use of all employees and supervisors and is not limited to the immediate work area. You are not required to give your name, department or phone number. All information received will be kept confidential.
Date: ________ / _________ / ________ Time of Day: ______________ a.m. or p.m.
Location of Unsafe Condition:
Existing Condition Which You Consider Unsafe:
Has This Been Reported to Anyone?
Other/Comments:
Name (Optional): _________________________ Phone No. (Optional)_________________
Department (Optional):_________________________________________________________
Place this form in a sealed envelope. You can turn this form in one of the
following ways:
• Give to any Safety Committee member.
• Drop off at City Hall Central Reception
• E-Mail to
• Mail: Attn: Safety Committee, City of Atascadero, 6500 Palma Avenue,
Atascadero CA 93422
C I T Y O F A T A S C A D E R O
Employee Safety Suggestion Form
This form is to be used by City employees to give any suggestions which in their opinion, would be of value and benefit to City operations, not solely related to safety but to any area where improvements can be made:
Date:________ / _________ / _______
Please give a thorough description of your suggestion:
Other/Comments:
Name (Optional): _________________________ Phone No. (Optional)_________________
Department (Optional):_________________________________________________________
You can turn this form in one of the following ways:
• Give to any Supervisor or Department Head
• Drop off at City Hall Central Reception
• E-Mail to the City Manager’s office, c/o Lisa Cava: lcava@atascadero.org
• Mail: Attn: City Manager’s Office, City of Atascadero, 6500 Palma Avenue,
Atascadero CA 93422