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department avatarRisk & Insurance Services Unit

Safety & Health Committee Information

Forming a safety and health committee at your site is essential.  Please review our Safety Committee Guidelines to assist you in developing your site based committee.  Once your committe is formed, please complete the contact information for your site and submit to Risk Management so we have current contact information.

Thank you.

Items marked with a * are required

Location




Site Safety Representative


First and Last Name of the Site Safety Representative


Include Area Code


Safety & Health Advisory Group Representative


First and Last Name of the Safety & Health Advisory Group Representative


Include Area Code


Safety Committee Member 1


First and Last Name


Include Area Code


Safety Committee Member 2


First and Last Name


Include Area Code


Safety Committee Member 3


First and Last Name


Include Area Code


Safety Committee Member 4


First and Last Name


Include Area Code


Safety Committee Member 5


First and Last Name


Include Area Code


Safety Committee Member 6


First and Last Name


Include Area Code


Additional Comments


Any additional information regarding this report.