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Health and Safety

Executive

Trade Union Safety Representative - raising a concern about workplace health and safety

 

This form is for Trade Union representatives only to report health and safety concerns. It is not for others making a complaint about or reporting a workplace issue. Advice on this is available on the HSE website.

 

This form should only be used by trade union appointed safety representatives who wish to report health and safety concerns that

have caused, or have the potential to cause, significant harm, that have not been resolved despite using their powers under the

Safety Representatives and Safety Committees Regulations 1977.

Anonymity and Disclosability Policy

Your details

*Contact details for preferred method of response from HSE (please provide at least one method of contact)

*Can HSE disclose your name when we follow up your concern?

Escalation

*Have you escalated this matter to the appropriate senior

representative or trade union official?

Do you know if this is only a local matter?

Do you know if this is an industry wide matter?


HSE Logo

Health and Safety

Executive

Trade Union Safety Representative - raising a concern about workplace health and safety

Concern details

*Have you taken any action under the Safety Representatives and

Safety Committees Regulations 1977?

Sharing of information

*Do you agree to HSE sharing all the information you give on this form with all

trade unions to help monitor the use of the Safety Representatives and Safety

Committees Regulations 1977?

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