Title Page
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Life Saving behaviours
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Conducted on
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Prepared by
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Location
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What state are you reporting from?
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Notify
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Type of report
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What was the hazard?
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What has been done to fix the hazard?
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Is further action needed?
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What was the near miss?
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What was done to prevent the near miss from happening again?
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What else needs to be done?
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What caused you to pause the job?
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What corrective action did you put in place?
