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Proud
1-360-577-9194
705 Colorado Street
Kelso, WA 98626
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Safety/Hazard Card
If you are human, leave this field blank.
Name
*
Division
*
Client/Sub/Vendor
Corporate
Environmental
Drilling
Fuel
Federal
Job #
Date
*
Time
Location of hazard/safety observation
Identified hazard/safety observation
*
What was the hazard you recognized?
Type of Issue
*
Please select the type of issue which BEST suits the situation. Examples: no PPE procedural, speeding in vehicle behavioral, lightning environmental, leaky machine equipment.
Equipment Issue
Environmental Issue
Procedural Issue
Behavioral Issue
Corrective action taken
*
What did you do to mitigate the hazard?
Suggested Solutions
*
What do you suggest AEC should do in order to prevent this issue from reoccurring?
Photos (if applicable)
This is not a requirement - please submit if it helps explain the hazard you are recording AND you are able to safely take the photo.
Email for Receipt
This field is not required. If you would like a receipt for your own records, please provide your email.
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