This form is to be used to report hazards, unsafe conditions, work practice and, in the opinion of the APWU, hostile work environments. You can use this form to report anything that you think could jeopardize your health: Dirty conditions, pests, mold, disturbed or broken building materials (tiles, insulation, etc.)
The form must be readily available and easily accessible to all workers on the workroom floor. You should not have to ask a supervisor for a form—they are not supposed to be locked up in a desk or stored where an employee cannot get them. The form can be submitted anonymously, but if it is you will not receive back a copy of the form that includes management’s actions to abate the problem.
The ELM in Section 824.6 has very clear explanations of how the form is to be used with both supervisor and employee responsibilities listed. The text of ELM 824.6 is below.
Although a fillable PDF form is included here on our website, we recommend that you utilize the 4-copy NCR form provided by the USPS in your workplace so that you can get your copy returned to you. By doing so, you can see what abate actions were completed or ignored. Also, having a copy helps your union representative if they need to file a grievance on the safety issue that is not being addressed.
If you have questions about the form, need help completing one, or can’t find one in your office, contact your local union representative.
Employee and Labor Relations Manual
Investigating Employee Reports of Hazard, Unsafe Condition, or Practice
824.61 Purpose of PS Form 1767, Report of Hazard, Unsafe Condition or Practice
PS Form 1767 is designed to encourage employee participation in the Postal Service safety and health program and to provide prompt action when employees report a hazard. This form provides a channel of communication between employees and management that promotes a prompt analysis and response with corrective action to reports of alleged hazards, unsafe conditions, or unsafe practices.
Supervisors must maintain a supply of PS Forms 1767 in the workplace in a manner that provides employees with both easy and (if desired) anonymous access.
824.63 Procedures and Responsibilities
a. Any employee, or the representative of any employee, who believes that an unsafe or unhealthful condition exists in the workplace may do any or all of the following:
b. File a report of the condition on PS Form 1767 with the immediate supervisor and request an inspection of the alleged condition.
c. If the employee desires anonymity, file PS Form 1767 directly with the installation’s safety personnel, who will immediately give the report to the employee’s supervisor for necessary action. (In such cases, safety personnel must not disclose the name of the individual making the report.)
d. Report alleged unsafe conditions to a steward, if one is available, who may then discuss the condition with the employee’s supervisor.
Discrimination against an employee for reporting a safety and health hazard is unlawful.
The immediate supervisor must promptly (within the tour of duty):
a. Investigate the alleged condition.
b. Initiate immediate corrective action or make appropriate recommendations.
c. Record actions or recommendations on the PS Form 1767.
d. Forward the original PS Form 1767 and one copy to the next appropriate level of management (approving official).
e. Give the employee a copy signed by the supervisor as a receipt.
f. Immediately forward the third copy to the facility safety coordinator.
It is the supervisor’s responsibility to monitor the status of the report at all times until the hazard is abated. If the hazard remains unabated longer than 7 calendar days, the supervisor must verbally inform the employee as to abatement status at the end of each 7-day interval.
824.633 Approving Official
The approving official (the responsible manager) must initiate action to eliminate or minimize the hazard.
a. If this results in the submission of a work order, attach the original PS Form 1767 and forward it, through channels, to the manager of Maintenance.
b. If the approving official determines that there are no reasonable grounds to believe such a hazard exists, the employee must be notified in writing within 15 calendar days. (Safety personnel must assist in this determination when requested.)
c. If the hazard was abated through actions of the approving official:
1. The employee must be notified in writing, and
2. The original PS Form 1767, with a statement of actions taken, must be forwarded to the safety office.
824.634 Safety Personnel and Collateral Duty Facility Safety Coordinators
Safety personnel assigned to plants and FSCs must log and sequentially number all hazard reports received on PS Form 1773, Report of Hazard Log, or if the FSC has computer access, enter the reports into the Hazard Log Module of the Safety Toolkit. Safety personnel and FSCs must also review all PS Forms 1767 for accuracy, completeness, and follow–up, as necessary. They must routinely provide status reports of PS Form 1773 logs and Safety Toolkit reports at executive and Joint Labor–Management Safety and Health Committee meetings (or regular staff meetings in facilities with fewer than 50 employees).
Maintenance must notify the approving official when any PS Form 1767 maintenance–related work order has been completed.
824.636 Installation Head
Installation heads/managers are responsible for responding promptly to hazard reports and ensuring that line supervisors are diligent in correcting hazards. If a hazard report indicates that imminent or serious danger exists, the installation head must take immediate corrective action.