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Report the Hazard
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Report the Hazard
Employee Name
Employee Email Address
Employee Phone Number
Employee Supervisor Name
Employee Supervisor Phone Number
Employee Supervisor Email Address
Address of Hazard or Building Name (ORB, Charlotte office, etc)
Location Description (room name/numbers or proximity to landmark)
Type of Hazard
Electrical Hazard
Environmental (animal, insect, heat/cold)
Equipment and Tools
Near hit/near miss
Property damage
Slip/trip/fall
Strike against moving or stationery object
Other (Provide details below)
Other Hazard Type
Detailed Description of Hazard Observed
Attach Pictures (if available)
One file only.
2 MB limit.
Allowed types: gif jpg jpeg png pdf doc docx ppt.
Was there an Injury as a result of the hazard?
Yes
No
Has corrective action been taken?
Yes
No
If "yes" describe corrective action
