Employee Safety Recommendation

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      This form is to allow employees of MachMotion to recommend possible safety and health concerns and offer a possible solution to resolve concerns. Please fill out this form as much as possible and email a picture (if applicable) of the safety concern to Aaron@machmotion.com.

Location: ______________________________     Department:_______________________________

Manager:_______________________________    Date:_____________________

Identification of Safety or Health Hazard

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Suggestion for Resolution of Safety or Health Hazard

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Do Not Write Below This Box

Date of Recommendation: __________

Investigated: __________

Investigated by: ___________________

Action Taken:

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Date of Action Taken was Reported to the Employee:______________________

Comments:

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