TDSB Health and Safety Concern/Near Miss Incident Form

A concern is defined as “a potential or existing hazard which presents risk to the health or safety of individuals in the workplace.”

Fill this form out if there is any health and safety issue (mold, paint fumes, dealing with a violent incident, concerns about unsafe conditions in a classroom).

This is the only form where the Principal must respond to you in writing within 5 business days.

Date the form, make a photocopy and maintain a copy before submitting. It is recommended that this form be completed and submitted along with other forms (e.g. Violent Incident Report) that may have been submitted, to ensure a response within the specified amount of time.

Any questions to the Board regarding this form should be directed to the TDSB Occupational Health & Safety Department at 416-397-3213

If you have any questions about this form, please contact your Executive Officer or the appropriate ETT Health and Safety Inspector.

Members are required to login to the TDSB website to access this document.


TDSB Health and Safety Concern and Near Miss Incident Form (Document)