Facility Safety Concern Form

Please use this form to report any health and safety hazards and incidents that occur at Kingsway Community Church.

Hazard or Incident

Brief description of hazard/incident:

Where is the hazard located in the church?

When was the hazard identified:

Recommended action to fix hazard/incident: (List any suggestions you may have for reducing or eliminating the problem - for example: maintenance work, update procedures, improve training)

Action Taken [For Safe Church Team Use]

Has the hazard/incident been acknowledged by Church Leadership/Safe Church Team?

Describe what has been done to resolve the hazard/incident:

Do you consider the hazard/incident fixed?

Issue resolved on:

Name of Safe Church representative: