Safety Forms

MVF YMCA and Family Wellness Incident Report 2023.pdf

Complete this form if you have an injury at work. Submit it to your supervisor who will submit it to the Safety & Employee Development Specialist. It needs to be submitted within 24 hours so it can be reported to Workforce Safety & Insurance. 

Click on the image of the form. A small box will appear to the top left of the form. Click on the square with the arrow pointing to the upper right. This will open the document in a new tab and allow you to open in Google Docs and complete. You can download and print it.

Incident report from Secura.pdf

Use this form for a non-employee incident. 

Click on the image of the form. A small box will appear to the top left of the form. Click on the square with the arrow pointing to the upper right. This will open the document in a new tab and allow you to open in Google Docs. You can download and print it.

Safety Hazard Concern Report 2023.pdf

Complete this form if you see a potential safety hazard that you want to report. You can submit it to the Safety & Employee Development Specialist.

Click on the image of the form. A small box will appear to the top left of the form. Click on the square with the arrow pointing to the upper right. This will open the document in a new tab and allow you to open in Google Docs and complete. You can download and print it.

accident_analysis_worksheet.pdf

Supervisors can use this form to conduct an accident analysis.

Click on the image of the form. A small box will appear to the top left of the form. Click on the square with the arrow pointing to the upper right. This will open the document in a new tab and allow you to open in Google Docs. You can download and print it.


Supervisor's Observations Reasonable Suspicion.pdf

Supervisors may complete this form when they have reasonable suspicion that a staff member may be abusing drugs or alcohol. 

Click on the image of the form. A small box will appear to the top left of the form. Click on the square with the arrow pointing to the upper right. This will open the document in a new tab and allow you to open in Google Docs. You can download and print it.