Hazard Hero Report Form

BE A HAZARD HERO

North Carolina’s Injury Prevention Program helps
find and eliminate hazards.

Each employee plays a role in stopping actions
that cause injuries and removing unsafe conditions.


Please complete the following section.
































Please attach any pictures or other documentation you believe will help identify the event and location.


Employees must check the box below prior to selecting "Submit". This will ensure you get a copy. Once you receive your copy of the Hazard Hero Report, we need you to forward it to your supervisor. Thank you!






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