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Safety and Security Concern Form
Please use this form to report a safety concern or safety hazard directly to Facilities Management Division (FMD) Safety and Security Unit. This is your opportunity to promote safety awareness. Please call 911 immediately to report emergencies that are an immediate threat to life or health to state employees and/or public. Work-related injury or illness should be reported to the employee’s supervisor and also to the FMD Safety and Security Unit.
You can complete form below or
print it here
Completed form can be faxed to: 505.476.2440
Name (First, Last):
Where is the location of the safety hazard or safety concern? Please be as specific and descriptive as possible.
What is the nature of the safety hazard or safety concern?
Have you reported this hazard or concern before? If so, when and to whom?
Please indicate what action was taken.
Suggestions for correcting hazard:
Questions or Comments:
General Services Department
Joseph Montoya Building // PO Box 6850 // Santa Fe, NM 87502 // (505) 827-2000
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