Health & Safety: Submit Concerns

FDNY Operational Issues Form

Please fill out the form below if you have firehouse issues that you feel might be jeopardizing your Health and Safety

After you fill it out, please press the "Submit Form" button at the bottom of the form to send it directly to the UFA Health & Safety Office.

Thank you!

Type of problem or concern:
Inter Agency Issues
Relief Issues
Relocation Issues
Response Issues
Special Events Deployment Issues
Other

Is this a new issue/problem or an existing one?
New Existing

If it is an existing problem, was it reported to the department?
Yes No

When was it reported to the department?

How many times was it reported to the department?

Do you have documentation of past reports?
Yes No

Briefly explain your complaint and the measures you've taken so far (i.e. have you contacted your delegate, the department or this office before regarding this matter)

Date:

Name:

Company:

Phone:

Email Address: