Please tell us about your unsafe workplace conditions.

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1. Enter your full name. (Required.)

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3. Enter your phone number (Required.)

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5. Enter your department. (Required.)

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6. Enter your work location. (Required.)

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7. Enter your job title. (Required.)

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8. Enter the description of your issue. (Required.)

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9. Upload a picture of the issue. (videos need to be submitted by e-mail)

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