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Indiana Department of Labor

DOL > INSafe > INSafe Home > INSafe Hazard Correction/Extension Request Form INSafe Hazard Correction/Extension Request Form

Please provide the following information for each hazard identified by the INSafe Safety or Health Consultant during your on-site consultation visit.  This online form, INSafe Hazard Correction/Extension Request Form, can be submitted in lieu of the paper copy that was sent with your INSafe Consultation Report.  Information to complete this form may be found on the Employer Report of Action Taken.  You may submit up to 20 hazard correction notifications or extension requests at one time.  If you have more than 20 hazards to correct or extensions to request, a subsequent submission is required.

For questions concerning hazard correction, please email or phone (317) 232-2688.

Required Field Required Field

Record information from Consultation Report


Hazard 1Hazard Correction
Extension Request


To upload attachments (files or photos), please email them to INSafe at