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Report a Safety Concern

2. What is the nature of your concern:
   -- Select One --Blocked Entry or ExitBroken or Worn EquipmentDriving or Vehicle RelatedFire HazardHazardous Work PracticeLightingMissing SignNeed for Supervision or MonitoringSurface Defect (Holes, Debris, Etc.)Other

3. Other Details

5. Does it have to do with:

   1. Fairbanks North Star Borough Facility Related
   2. School Related

   1. Work-Related
   2. Other

6. Please Explain

8. When did you observe the situation:
   When did you observe the situation:

9. What to you think should be done:

11. If you want us to contact you please provide contact information.

13. How to contact you:

    1. Email
    2. Phone

14. Name

15. Email

16. Phone

Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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