The Power of the PS Form 1767
What is a 1767?
A Powerful Form!
(PS FORM 1767-Report of Hazard, Unsafe Condition or Practice)
- Officially documents and addresses employee’s safety hazards or concern in writing.
- Requires a timely written response during your tour by management consistent with ELM Section 824.632.
- It is tracked and identifies abatement date.
- The Joint Local Safety and Health Committee is required to review all 1767s at their meetings.
- User friendly form that is easy to complete – instructions are clearly printed on the back of the form.
The form must be readily available for an employee to use!
Not locked in a supervisor’s desk or any non-accessible area.
The employee must be provided a signed copy of the form (blue copy). It is also suggested you have your union representative make a copy before it is submitted to the supervisor.
This form can be used to document other safety and health related concerns as well (i.e. housekeeping issues, buildings not maintained, dirty bathrooms, bad lighting, abusive supervisors, etc.).
The form may also be completed anonymously and submitted directly to the safety office.
Text SAFETY to 91990 for link to the PS 1767 page.
For more information and assistance in establishing your own safety and health committee, please contact Your Regional Coordinator or Your Regional Safety Rep.
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