Title Page
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Document No.
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Audit Title
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Farm
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Conducted on
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Prepared by
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Location
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Personnel involved
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Was anyone injured?
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Was any equipment damaged?
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If you answered yes to any of the above then it was an incident not a near miss. Please submit full report to your manager.
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Brief description of near miss incident.
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Take photo of any issues or upload one from your device
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Has hazard been added to hazard board and reported?
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Signature of employee reporting
