Anonymous Employee Feedback Form Health & Safety Committee Purpose: This form is for employees to provide feedback, concerns, or suggestions related to workplace health and safety. Submissions are anonymous unless you choose to identify yourself. Type of FeedbackSafety ConcernHazard ObservedPositive Feedback/recognitionSuggestion for improvementOtherDescription of Concern, Hazard, or SuggestionRisk Level Low -Minimal risk, unlikely to cause harm Moderate – Could cause injury/illness if not addressed High – Immediate danger, Likely to cause harm Suggested SolutionAdditional CommentsContact Information (optional) Δ
