JWSHSC Recommendations Form - SAMPLE JWSHSC Recommendation To: cc’d: Work Site: Date: MM/DD/YYYY From: Joint Work Site Health and Safety Committee _______________________________ _________________________________ (Co-chair Signature – Worker Representative) (Co-chair Signature – Employer Representative) Please Respond by: MM/DD/YYYY Health and Safety Issue: Provide a short, clear, and complete description of the issue. Include what, where, why, when, and who (if applicable). JWSHSC Recommendations: Provide a clear and complete description of the recommendation to resolve the above health and safety issue. Provide justification for the recommendations, other possible options, steps involved, and suggested time frames for completion. Attach a separate sheet if necessary. Committee Consensus on Proposed Recommendation: Yes No Comments: Employer Response: Provide a time frame for completion of accepted recommendations. Provide reasons for rejected recommendations. Attach a separate sheet if necessary. ___________________________ __________________________ _______________ Name – Employer Signature – Employer Date Returned Committee Comments: Note any follow-up or additional actions that may be required.
JWSHSC Recommendations Form - SAMPLE JWSHSC Recommendation To: cc’d: Work Site: Date: MM/DD/YYYY From: Joint Work Site Health and Safety Committee _______________________________ _________________________________ (Co-chair Signature – Worker Representative) (Co-chair Signature – Employer Representative) Please Respond by: MM/DD/YYYY Health and Safety Issue: Provide a short, clear, and complete description of the issue. Include what, where, why, when, and who (if applicable). JWSHSC Recommendations: Provide a clear and complete description of the recommendation to resolve the above health and safety issue. Provide justification for the recommendations, other possible options, steps involved, and suggested time frames for completion. Attach a separate sheet if necessary. Committee Consensus on Proposed Recommendation: Yes No Comments: Employer Response: Provide a time frame for completion of accepted recommendations. Provide reasons for rejected recommendations. Attach a separate sheet if necessary. ___________________________ __________________________ _______________ Name – Employer Signature – Employer Date Returned Committee Comments: Note any follow-up or additional actions that may be required.