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Safety Feedback Form

Please use the form below to report a safety concern or "near miss" that you have witnessed. The information will remain confidential. Required fields are highlighted below.

Near Miss Date:
Atlas Employee:
Time:
Employee Phone:
Location:
Witness:
Observation:
Immediate cause(s):
Near Miss Type:
Underlying cause(s):
Client:
Corrective action(s):
Project: