KP Safety Concern — UFCW Local 7

KAISER SAFETY CONCERN

Thank you for submitting a safety concern with UFCW Local 7. By submitting this concern you understand that this is not a substitute for your duty to report safety issues through your employer’s internal safety reporting process. UFCW Local 7 advises you to report all issues into the internal reporting portal. For Kaiser Permanente workers that portal is Safety Connect. Furthermore, we advise you not to share protected health information through this reporting link.

Name

First Name

Last Name

Cell Phone

(###)

###

####

Facility

Date of Safety Issue

Approximate Time of Safety Issue

Based on my professional judgment I am unable to assure the delivery of safe and/or adequate healthcare due to this safety issue

Yes

Description Of Safety Concern