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HEALTH CONCERN / SAFETY HAZARD / CHEMICAL SPILL REPORT FORM

SUGGESTED CORRECTIVE ACTION or ACTION ALREADY TAKEN

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Referenced from: Emergency Procedures & Lockdown

Document text

HEALTH CONCERN / SAFETY HAZARD / CHEMICAL SPILL REPORT FORM

CHECK APPROPRIATE CONCERN:

  • HEALTH CONCERN

  • SAFETY HAZARD

  • CHEMICAL SPILL

  • Immediate

  • Immediate

  • Immediate

  • Probable

  • Probable

  • Probable

NAME: (Optional)

DATE:

CAMPUS:

LOCATION / ROOM NO.

DETAILS:

SUGGESTED CORRECTIVE ACTION or ACTION ALREADY TAKEN

IF CHEMICAL SPILL:

Is area sealed off?

  • YES NO

Is the chemical known

  • YES NO

Name of chemical if known:

NOTE: Never handle chemicals for which you have not been trained. You must use proper personal protective equipment.

Source: https://www.northerncollege.ca/uploads/2025/07/HSE-Hazard-Report-Form.pdf