PTASP Safety Hazard Reporting Form

Frontline employee form to report safety hazards, unsafe conditions, and near-miss risks that could cause injury, death, or equipment damage. Supports agency Safety Risk Management under 49 CFR Part 673.

Report Overview

• What are you reporting?
• Brief description of the hazard
  Describe the condition, what could happen, and why it is unsafe. Keep it factual and specific.
• Is there immediate danger right now?
• What immediate action was taken?
  Select all that apply.

Location and Asset Details

• Location type
• Location details
  Enter the specific station name, route, vehicle number, bay, room, or other precise location.
• Asset or system affected
  Select all that apply.
• Date observed
• Time observed

Hazard Characteristics

• Hazard category
• Describe the unsafe condition
  Include what you saw, heard, smelled, or measured. Avoid speculation.
• How often does this hazard occur?
• Environmental factors
  Select any conditions that may have contributed.

Potential Impact

• What could happen if this is not corrected?
  Select all that apply.
• Estimated severity
• Estimated likelihood

Evidence and Follow-up

• Photo evidence
  Upload one or more photos if available. Do not include faces unless needed for safety review.
• Additional details
  Include witness observations, prior occurrences, or temporary controls already in place.
• Reporter contact information
  Optional. Provide only if you want follow-up. If you submit anonymously, leave this blank.
• PII and safety review disclosure