Questions Form

Name *

Lastname *

Telephone

Mobile

E-mail

What kind of relation do you have with ABASTECEDORA Y COMERCIALIZADORA PARA LA MINERIA LIMITADA?

Relation Type

Is the company management aware of this problem?

Yes

I dont Know

Indicate estimated date when the incident happened

For how long do you think this problem have been happening?

The employee belongs to a contractor company?

Company

Area

Involved Name *

Involved Lastname *

Involved Charge *

Where did this incident or infraction happened? *Indicate location, floor area, or any data of te place that can help to identify it

How did you notice this infraction?

Supply all related details with the infraction, witnesses locations and any other valuable information and final resolution of this situation

If this action provokes or might provoke a security, Occupational or environmental health problem, please write it down

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