Safety Concern and Accident Report Form

Members, employees and volunteers shall use this form to report injuries, illnesses, or “near miss” events. This report is required for any injury on MakeHaven property that requires anything more than basic first aid. This helps MakeHaven to identify and correct hazards before they cause serious injuries. This form shall be completed by as soon after the incident as possible.

Note: Please fill and refrain from making humorous comments. This is reviewed by a committee of the board and potentially others.