E.Y.E.S. Form

2. Instructions
   Employees Yielding Effective Safety (E.Y.E.S.) is a program to help identify maintenance deficiencies noted in normal operations. If the deficiency is an emergency condition, please notify the necssary department: Public Works: 928-634-8033; Police: 92-634-4246. All Forms should be sent to the Human Resources/Risk Management Department. For questions, call 928-340-2713.

   Employees Yielding Effective Safety (E.Y.E.S.) is a program to help identify maintenance deficiencies noted in normal operations. If the deficiency is an emergency condition, please notify the necssary department: Public Works: 928-634-8033; Police: 92-634-4246. All Forms should be sent to the Human Resources/Risk Management Department. For questions, call 928-340-2713.

4. Incentive
   Employees submitting E.Y.E.S. reports will be eligible for a quarterly drawing.

   Employees submitting E.Y.E.S. reports will be eligible for a quarterly drawing.

6. First Name

7. Last Name

9. Department

10. Date

12. Deficiencies (Check all that apply):

    1. Improper Use of Signs (Businesses, Yard Sales, etc.)
    2. Junk Vehicles
    3. Street & Park Light Outages
    4. Potholes
    5. Trip Hazards
    6. Excessive Weeds
    7. Excessive Debris in Street
    8. Excessive Debris in Culverts or Washes
    9. Street Signs OR Banners (Damaged, Graffitied)
    10. Traffic Signal Malfunction (non-emergency, Example: Light partially out)
    11. Unauthorized Dumping (Trash & Brush)
    12. Damaged Public Facilities (Broken Sinks, Toilets, etc.)
    13. Street Safety Hazard

    1. Trees Down
    2. Safety Hazards in Parks
    3. Potential Storm Water Violation (Oil, Erosion, Water when not raining, etc.)
    4. Landscape Issue in Median
    5. Water Leaks - Water Mains, Hydrants, Sprinklers
    6. Unauthorized Use of Fire Hydrants
    7. Handicap Deficiencies (Fixtures, etc.)
    8. Traffic Sight Obstruction (Bushes, Trees, Vehicles, etc.)
    9. Unfenced Pools
    10. Unauthorized Grading
    11. Unauthorized Painting
    12. Other: Write Description in area below

14. Exact Location of Problem (required):*

16. Nearest Cross Streets:

18. Detailed Description of Problem or Issue:

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field