Information
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Organization Inspected
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Conducted on
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Inspection conducted by:
Findings
Finding 1
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Date/Time
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Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
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Give description:
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Room
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Functional Area or Shop:
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Supervisor or POC:
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Phone Number:
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Hazard or Deficiency:
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Finding:
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Reference:
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Is this a hazard or deficiency?
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RAC
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Assign RAC:
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Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
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Recommendation:
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30 Day Follow-Up Date:
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Corrective Action:
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Supporting Picture:
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Would you like to add another finding?
Finding 2
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Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
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Is this a hazard or deficiency?
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RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 3
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 4
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 5
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 6
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
Findings (Con't)
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Would you like to add more findings?
Finding 7
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 8
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 9
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 10
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 11
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture:
-
Would you like to add another finding?
Finding 12
-
Date/Time
-
Building
- 2000
- 911
- 888
- 887
- 885
- 883
- 872
- 846
- 220th
- Unlisted
-
Give description:
-
Room
-
Functional Area or Shop:
-
Supervisor or POC:
-
Phone Number:
-
Hazard or Deficiency:
-
Finding:
-
Reference:
-
Is this a hazard or deficiency?
-
RAC
-
Assign RAC:
-
Cause:
- Training
- Equipment
- Technical Data
- Human Error
- Misconduct
- Process Inadequate or Faulty
- Leadership/Supervision
- Other
-
Recommendation:
-
30 Day Follow-Up Date:
-
Corrective Action:
-
Supporting Picture: