report – Energy Star Lighting Electric Inc

Safety Issue Report Form

Your contact information

Name *

Phone *

Email *

Location

Address

Cross streets

GPS coordinates how?

Address

Country

City

State

Zip code

Cross Streets

GPS coordinates

Business type/name or location type/name *

Issue you're reporting on *

Immediate safety concern

Potential safety violation

Safety suggestion

Other

Describe *

Please be as detailed as possible

Photos

multiple files can be selected when uploading

Consent Agreement *

By submitting this form you consent to be contacted and further agree that you will disclose any additional details to the Energy Star Lighting & Electric Inc. Safety Manager, Director of Operations or the CEO as required by the investigation of the subject matter in question. In submitting this form you express understanding that all statements made on this form can be used as evidence in the court of law. Furthermore, you agree to give up ownership copyright rights at the moment any photos, videos or any other content is uploaded via this form.

I Agree

If you’d like to report anonymously, please use this form: https://esleinc.com/report/anonymous-issue-report/