Title Page
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Prepared by
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Accident/Incident Location
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How was you first contacted?
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Incident description(Brief summary of what happened)
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Impact to site(Examples: Lost Production, water damage, safety issue)
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Immediate Containment action?(What was done to mitigate impact and prevent further injury or loss?)
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Initial root cause?
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Notification/work order number
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Is a formal root cause required?
- Yes
- No
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Incident notes:
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