Information
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Organization Unit.
- 101
- 201
- 202
- 203
- 206
- 207
- 208
- 221 or 223
- 222
- 228
- 301
- 502, 505, or 507
- 550
- Other (List any information you wish to identify area needing improvement)
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Conducted on
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Optional: Enter your name, Service Ticket #, Job #, and/or Project #.
Close Call
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Briefly describe the (potential) incident.
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List cause(s) - find facts, not fault.
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Suggest a solution to make it safe.
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Bonus: Take a picture of the (potential) incident and/or corrective action.
