AICP Safety Reporting Form

Please use this form to report specific factual matters of safety concern you have observed or encountered on-site that pertain to the AICP COVID-19 Workplace Guidelines & Considerations (herein the “Guidelines”). All submitted information will be kept confidential and will not be shared with anyone other than AICP staff assigned to review and act on such reports. Your report will be reviewed and if deemed sufficiently factual and related to the Guidelines, other COVID-19 safety practices or conditions, AICP staff will contact the company’s owner or senior management to inform him/her of the issues and related facts reported by you, in good faith, as an on-site employee: your name will not be revealed to the Company. If AICP decides not to contact the Company it will advise you of that decision.

Submitter’s Information

Name^*

Email Address^*

Phone Number^*

Incident Being Reported

Name of Company^*

Specific Job (if applicable)

Date of Incident

Your Position on the Job

Factual Points of COVID-19 Safety Concern

Have you reported your concerns to anyone in authority?

Please describe your concern in as much detail as possible.

Use of this form is voluntary and is not intended as the exclusive process for reporting the facts contained therein. AICP is not a safety compliance enforcement agency, does not provide legal advice, is not your legal or other representative and it will not transmit the information reported by you to any governmental agency, labor organization or other third party unless required by applicable law. As a special service to the commercial production and post-production industry during this pandemic crisis, AICP has undertaken but is not obligated to bring the facts you report to the attention of the Company’s responsible personnel in order to give the Company the opportunity to investigate and take necessary appropriate remedial action, as it determines. AICP is not responsible for remediation and will not monitor the Company’s follow up actions.