Notice of safety concerns/unsafe conduct utilizing GSE/ ETV/ CHS
This notice is provided to you as a courtesy with the sole interest to maintain and improve the safety of everyone!
Email delivery ver 4/2026
Instructions/qualifications
Information Page
SAFETY STATEMENT
Accident and incident prevention is the responsibility of all employees. Preventing accidents shall be a primary consideration in all phases of our operations and administration. It is our intention as a company to provide a safe and healthy work place and prevent damage to property and commodity. These policy extends to any customers and any of their properties and facilities. Casaria will establish and insist upon safe work practices by all employees at all times. All supervisors must make employee safety an integral part of his or her management duties. Each employee must accept and follow all established safety, loss control and risk management regulations and procedures.
Report Type *
Date/Time of report *
Name & Location of facility
Report Prepared by *
Your employee's name *
Other personnel participating
Remarks/Notes (i.e reason for Ad-Hoc or Re-Inspection)
Notice given to company *
Safety concern details
Area of concern
Unsafe conduct observed *
Individual concerned
Personnel or process/policy concerned
Tim's Test
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