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Complaint, Health Hazard / Injury to Premises LandlordTenant Use this form if you are a landlord, your tenant has created a health hazard and injury to premises, you have given the tenant notice to

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How to fill out complaint health hazard injury

How to fill out a complaint health hazard injury:

01

Start by providing your personal information in the designated fields. This includes your full name, address, contact number, and email.

02

Specify the date and time of the incident when the health hazard injury occurred. Be as accurate as possible to establish a timeline.

03

Describe the nature of the health hazard injury in detail. Explain what happened, how it occurred, and provide any relevant information about the hazardous conditions that led to the injury.

04

If there were any witnesses to the incident, include their names and contact information. Their statements can support your claim and provide further evidence.

05

State the extent of your injury and any immediate medical attention or treatment that was required. Include medical records or documentation if available.

06

If there were any documents or reports associated with the hazardous conditions, attach them as supporting evidence. These may include incident reports, safety inspections, or photographs.

07

Explain how the health hazard injury has affected your daily life, including any physical or emotional distress experienced as a result. This helps convey the impact of the incident.

08

Sign and date the complaint form to certify its accuracy and completeness.

Who needs a complaint health hazard injury?

Individuals who have suffered a health hazard injury due to hazardous conditions in a workplace, public space, or private property are the ones who need to file a complaint. This can include employees, customers, visitors, or anyone who has been harmed by the said conditions. Filing a complaint is essential to raise awareness, seek appropriate action, and potentially claim compensation for the damages endured.

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