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)
Date of Report *
MM
/
DD
/
YYYY
Specify the interaction, area, activity, work task, process, equipment and material that potentially exposes employees or students to COVID-19 hazards. *
State the places and times the hazard occurred. *
Identify the potential for COVID-19 exposures and employees and/or students affected, including members of the public and employees of other employers. *
Identify any existing and/or additional COVID-19 prevention controls, including barriers, partitions and ventilation. *
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