Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Event Date & Time:
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Name of person reporting Close Call:
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E-mail address:
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Mobile Telephone Number:
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Close Call Location:
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Close Call Description:
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Photo of close call:
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Have you been able to resolve the issue?
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What action have you taken to prevent any harm/damage?