DA FORM 4755 Fillable – Army Pubs 4755 PDF

DAFORMFILLABLE.COM | DA FORM 4755 Fillable – Army Pubs 4755 PDFDA FORM 4755, known as the Employee Report Of Alleged Unsafe Or Unhealthful Working Conditions, is a vital tool for employees to formally report hazardous workplace conditions. This form, regulated by the Department of the Army Safety Program (DAS), ensures that employees can voice their concerns about safety and health without fear of retaliation. The form, first issued on October 1, 1978, remains an active component of workplace safety procedures today.

DA FORM 4755 – Employee Report Of Alleged Unsafe Or Unhealthful Working Conditions

Form Number DA Form 4755
Form Title Employee Report Of Alleged Unsafe Or Unhealthful Working Conditions
Form Date 10/01/1978
Form Proponent DAS

Importance of DA FORM 4755

Ensuring Workplace Safety

The primary purpose of DA FORM 4755 is to document and address unsafe or unhealthful working conditions. By providing a structured method for reporting, the form helps in identifying and mitigating risks that could potentially harm employees. This proactive approach to workplace safety not only protects employees but also enhances overall operational efficiency.

Utilizing DA FORM 4755 is essential for compliance with PAM 385-10, the prescribing directive that outlines safety and health regulations within the Army. Ensuring compliance with these regulations is crucial for maintaining a safe working environment and avoiding legal repercussions.

How to Complete DA FORM 4755

Step-by-Step Instructions

  1. Employee Information: Fill out personal details including name, position, and contact information.
  2. Description of Hazard: Provide a detailed description of the alleged unsafe or unhealthful condition. Include specific locations, times, and any witnesses if applicable.
  3. Impact on Safety and Health: Explain how the condition affects safety and health in the workplace.
  4. Proposed Solution: Suggest potential solutions or corrective actions to address the hazard.
  5. Signature and Date: Sign and date the form to validate the report.

Submission Process

Once completed, DA FORM 4755 should be submitted to the designated safety officer or department responsible for workplace safety. This ensures that the report is reviewed and appropriate actions are taken to address the reported conditions.

Benefits of Using DA FORM 4755

Empowering Employees

By providing a formal mechanism for reporting, DA FORM 4755 empowers employees to take an active role in maintaining their safety and health at work. This empowerment leads to a more engaged and conscientious workforce.

Improving Safety Standards

Regular use of DA FORM 4755 contributes to the continuous improvement of safety standards. Each report provides valuable data that can be analyzed to identify common hazards and develop more effective safety protocols.

Promoting a Culture of Safety

A workplace that actively encourages the use of DA FORM 4755 fosters a culture of safety. This culture prioritizes the well-being of employees and demonstrates a commitment to maintaining a safe and healthy working environment.


DA FORM 4755 – Employee Report Of Alleged Unsafe Or Unhealthful Working Conditions is an essential document for ensuring workplace safety within the Army. Its structured approach to reporting hazards not only protects employees but also promotes a proactive safety culture. By understanding and utilizing this form, employees can contribute to a safer and healthier working environment for all.

For more information and to access DA FORM 4755, visit the official Army publications website or contact your workplace safety officer.

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