HomeMy WebLinkAbout106.059 - FD-54, Member Report of Unsafe Condition
ADMINISTRATIVE MANUAL
FORMS
106.059 MEMBER REPORT OF UNSAFE CONDITION
(FD-54)
EFFECTIVE: SEPTEMBER 2008
Current Revision Date: 9/11/18 Next Revision Date: 09/11/23
Author’s Name/Rank: Brad Driscoll, Battalion Chief Review Level: 5
Section 106.059
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PURPOSE
The purpose of this form FD-54 provides a mechanism for employees to report an
unsafe condition or hazard for the Fresno Fire Department (FFD or Department).
APPLICATION
This policy is to provide information pertaining to the condition of a building,
equipment and/or personal protective equipment including corrective action(s).
OPERATIONAL POLICY
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OPERATIONAL GUIDELINE
Any member who identifies a specific hazard which could lead to a possible injury or
financial loss should complete this report. The report should include a description of
the unsafe condition and a recommendation of corrective action (s).
PROCESS
The (FD-54) form channels through Battalion Chief to Safety Committee
Chairperson.
INFORMATION
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Section 106.059
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DEFINITIONS
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CROSS REFERENCES
Standard Operating Procedures
Section 203.007, Injury and Illness Prevention Program
Section 106.059
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FD-54
FRESNO FIRE DEPARTMENT
MEMBER REPORT OF UNSAFE CONDITION
(IPP FORM 2)
Description of unsafe condition(s) or procedure(s)
Time and date of occurrence
Location of hazard
Recommended changes to correct condition
Member Signature (optional)
Received by Date
(Name of Supervisor)
Name of management personnel notified
(Name of Supervisor)
Are warning signs prohibiting entrances or barriers required due to imminent hazard? Yes No
Has this been discussed with other shifts? Yes No
Corrective action taken (if any)