Employee Safety Suggestion Form

Name:
City Department:
Phone #:
E-mail:

Date

Please briefly describe Current Conditions:

Your suggestion to Improve Conditions:

Has this suggestion or condition been reported to your supervisor?

Yes No

Please forward any supporting materials such as photos, drawings, additional documents by interoffice mail to:

Risk Management Department,
Attn. Safety Coordinator

Thank you for supporting the City of Waco Safety Program!