Health and Safety Forms From Council 220:

  • SSA-516 - Occupational Injury and Illness Report

  • Abatements - a multi purpose form to request an investigation of any health and safety problem found in an inspection and/or your observations. This form is more suited to a report from a coworker or a third party...

  • Communicable Disease - Request a medical exam after interviewing a member of the public with a communicable disease.

  • Identification of Local Health Service Needs - Request for location of Low cost/No Cost local medical providers.

  • Lease - Easy to fill in request for the lease.

  • Mold - Report mold or wet conditions in your office and request abatement -Easy to fill in.

  • Temperature - Too hot or too cold? Ask for inspection.

  • Violence - Easy to fill in request to investigate public actions or threats.

  • Referral of hazard to Council - If you are dissatisfied with management's actions on a report of hazard, you can request escalation to Council 220's H&S representative - This easy to fill in form refers the problem to the national level.

  • Incident Report - Request a copy of an incident report.

  • Imminent Danger - Use where a hazard presents an immediate and serious probability of loss of life or bodily harm.

  • Serious Condition - Request an inspection be done within 3 days

  • Smoking - Request to attend a stop smoking class.  Good luck!  You'll save a fortune!