SCHOOLS INSURANCE PROGRAM FOR EMPLOYEES (SIPE) - Resources

SAFETY SUGGESTION

Please complete the form below to make a safety suggestion. Our district welcomes your ideas and concerns and together we can achieve a safer and healthier work environment.

By completing this form, you are not placing a work order. Allowable suggestions will be taken to the safety committee for discussion and possible action. Thank you for your concern.

Required fields are denoted with *.

District Name*:

Your Name (you may remain anonymous):

Location* (site name, building name or number, etc.):

Your Email or Phone Number:

Explanation of Suggestion*:

What benefit will be received if the suggestion is implemented?:

In your opinion, is there an immediate health or safety concern if the idea is not implemented?*: Yes No Unsure Please select an option.

Please explain:

Is there a cost associated with the suggestion (optional)?: Yes No Unsure Please select an option.

Estimated Cost:

Supervisor's Name*:

Supervisor's Email Address*:

Confirm Supervisor's Email Address*:

Send a copy to:

Important Note: Some school districts filter their emails for spam. Make sure your district's spam filter will accept email from safetyreport@slosipe.org.