DA Form 4755. Employee Report of Alleged Unsafe or Unhealthful Working Conditions

Form DA 4755 is used as an Employee Report of Alleged Unsafe or Unhealthful Working Conditions in the Army. This form serves as a reporting tool for Army employees to raise concerns about potential safety hazards or unhealthy working conditions in the workplace.

The form consists of sections where the specific details of the alleged unsafe or unhealthful conditions are recorded, including the location of the concern, a description of the issue, and any supporting information or evidence. It includes information about the reporting employee and any witnesses to the reported conditions. Additionally, the form may include sections for indicating any immediate actions taken to address the concern and for tracking the follow-up investigation and resolution.

Important fields in this form include accurate documentation of the alleged unsafe or unhealthful conditions and proper indication of any supporting evidence or witness statements. Accurate completion of this form is crucial to ensure a safe and healthy work environment for Army employees.

Application Example: An Army civilian employee notices a potential safety hazard in their workspace, such as faulty electrical wiring. The employee completes Form DA 4755, providing a detailed description of the unsafe condition and any evidence or witness statements related to the concern. The completed form is then submitted to the appropriate safety officer or facility manager for investigation and corrective action. By doing so, the Army can promptly address safety hazards and maintain a secure working environment for its personnel.

Individuals filling out this form should consider any additional guidelines or procedures provided by the Army's safety and occupational health programs.

Related Forms: There may not be direct alternatives to Form DA 4755, as it serves as a specialized employee report form for unsafe or unhealthful conditions in the Army. However, there might be other forms related to workplace safety reporting or employee feedback used in similar military and civilian workplace settings.