PDF versions require acrobat reader, DOC versions require Microsoft Word
AbatementsA multi purpose form to request an abatement of any health and safety problem found in a 5510 review, your observations. To get an SSA-127 form, go to the EIS INTRAnet page, click on Facilities Management, then on OHEOS (the Office of Environmental Health and Occupational Safety, then on EHS forms and FAQ. From there you can download the SSA-127 form. |
Request for notice of InspectionArticle 9, Section 3.A permits Union representatives to accompany inspections (SSA controlled or outside inspectors). Use this to request notice of the inspections and to accompany management. Note: The Local President decides whether you can accompany management as the use of bank time is involved. |
Referral of hazard to councilIf you are dissatisfied with management's actions on a report of hazard, you can request escalation to Council's H&S representative. This form refers the problem to the national level. Send to the National Health and Safety Committee members Howard Egerman or Ginny Harris. |
Communicable DiseaseRequest a medical exam after interviewing a member of the public with a communicable disease |
MoldReport mold or wet conditions in your office and request abatement |
Incident AlertRequest a copy of an incident report
|
Low or Now Cost HealthRequest for location of Low cost/No Cost local medical providers |
TemperatureToo hot or too cold, ask for inspection |
Imminent DangerUse where a hazard presents an immediate and serious probability of loss of life or bodily harm. |
LeaseRequest a copy |
ViolencePublic actions or threats |
Serious ConditionRequest an inspection be done within 3 days
|
SmokingRequest to attend a stop smoking case |