Coos Bay School District
Safety Concern Form


School Name____________________________ Date_____________________

Location of
concern______________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

SAFETY/FIRE/HEALTH ITEM OF
CONCERN____________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________


(Optional)
Name of person submitting concern _____________________________________________________

 

This form may be printed.  You can turn it in to your supervisor, any of the Safety Committee Members, or Rod Danielson, Business Manager.