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Identification of COVID-19 Concerns/Hazards
This form is for the purpose of identifying school/workplace-specific hazards or concerns.
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Person Reporting Concern/Hazard (optional)
Your answer
Date of Report
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MM
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DD
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YYYY
Specify the interaction, area, activity, work task, process, equipment and material that potentially exposes employees or students to COVID-19 hazards.
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State the places and times the hazard occurred.
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Identify the potential for COVID-19 exposures and employees and/or students affected, including members of the public and employees of other employers.
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Identify any existing and/or additional COVID-19 prevention controls, including barriers, partitions and ventilation.
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