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Click ‘Get Form’ to open PS Form 1767 in the editor.
Begin by filling out Section I, where you will describe the hazard, unsafe condition, or practice. Be specific and clear about the issue you are reporting.
In Section I, provide your signature and date to confirm your report. If you wish to remain anonymous, submit this section directly to the Safety Office.
Move to Section II for your supervisor's action. This section is typically filled out by them after they investigate the reported issue. Ensure they sign and date it after taking necessary actions.
If applicable, Section III should be completed by the approving official who will document any corrective actions taken. They must also sign and date this section.
Finally, ensure that all copies of the form are distributed correctly: original to the Safety Office, yellow copy to the approving official, and blue copy returned to you as a receipt.
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