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Run: Employee Safety Reporting Program Form

Use this employee safety reporting form to capture hazards, near misses, unsafe conditions, and service risks in one non-punitive submission. It supports PTA...

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Report Overview

What are you reporting? (required)

Submit anonymously

Select this if you do not want to provide your name or contact details. Do not include PII in the report narrative if you choose anonymous submission.

Yes No N/A

Brief summary of the concern (required)

Date observed (required)

Time observed

Location and Asset Details

Where did this occur? (required)

Location name or identifier (required)

Asset involved

Select all that apply.

Route, line, or service number

Safety Concern Details

Describe the concern or event (required)

Primary hazard category (required)

Is there an immediate danger to employees, passengers, or the public? (required)

What immediate action was taken?

Select all that apply.

Contributing factors

Select all that may have contributed.

Impact and Follow-Up

Did anyone get injured or was there property damage? (required)

Injury severity

Service impact

Recommended follow-up or corrective action

Reporter Information and Consent

Your name

Your email

Your phone number

I consent to being contacted for clarification or follow-up on this report

Your contact information will be used only for safety review and follow-up related to this submission.

Yes No N/A

I understand this report is part of a non-punitive safety reporting process (required)

Reports are reviewed for safety improvement, not discipline, except where required by law or policy.

Yes No N/A

Get your results

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Email (required)

Your name (optional)

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