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Room / Area
Type of Work Performed
Scrub and Recoat
Strip and Wax
Non ISS Personnel
Other People Working in Area
Number of People
Equipment Issues or Comments
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
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