Core Rules

Chapter 296-800 WAC

Report of a Workplace Hazard
Helpful Tool

This is an optional form that either an employee or employer can use to report a hazard. Use with WAC 296-800-120 Employee Responsibilities and WAC 296-800-140 Accident Prevention Program.

If you complete this as an employee, give a completed copy to your employer. If you don't want to include your name on the form, make sure to give enough details about the hazard so your employer can recognize and correct it.

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Sample form for modifying