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GCA Safety Alert
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Name
*
First
Last
Email
*
Phone
Multiple Choice
*
Injury
Motor Vehicle Incident
Thermal Event
High Potential Near Miss
Other
factors What Multiple
Brief description of incident.
*
Example: Employee smashed his thumb using a hammer.
How did this event occur?
*
What are some of the factors contributing to this incident?
*
What corrective actions are being taken to avoid this in the future?
*
Photos of Incident
Drag & Drop Files,
Choose Files to Upload
Include any photos of the incident but avoid colors and logo branding if possible.
Submit
