Please tell us about your unsafe workplace conditions.

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* 1. Enter your full name.

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* 3. Enter your phone number

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* 4. Choose your employer

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* 5. Enter your department.

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* 6. Enter your work location.

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* 7. Enter your job title.

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* 8. Enter the description of your issue.

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

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