Form: Raising and resolving a safety concern

Before you submit this form please ensure you have read the Raising and resolving safety concerns on your facility page.

PART 1: ELIGIBILITY

I am a member of the offshore petroleum workforce

I have raised my safety concern with my line manager and/or Health and Safety Representative

PART 2: INFORMATION ABOUT YOU

In order to collect meaningful feedback, please provide your name and at least one form of contact. For more information about how NOPSEMA collects and uses personal information read our privacy policy.

Name

Email address

Telephone

I consent to NOPSEMA contacting me for clarification and to be kept updated.

When would you prefer NOPSEMA to contact you?

Please do not share my information with the facility operator and/or my employer.

NOPSEMA will make every effort to safeguard your identity.

PART 3: WHAT IS YOUR SAFETY CONCERN?

In order for NOPSEMA to understand and address your safety concern all fields in this section must be completed.

What is the name of the facility you work on?

Let us know your safety concern

What action would you like NOPSEMA to take?

Form: Raising and resolving a safety concern

PART 1: ELIGIBILITY

PART 2: INFORMATION ABOUT YOU

PART 3: WHAT IS YOUR SAFETY CONCERN?

About this form

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