Title Page
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Conducted on
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CCTV Viewed by
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Location
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Other area listed below
Camera Number and Area being viewed
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No: and Area
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Date and Time being viewed on CCTV
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Reason for viewing CCTV
- Accident / Incident
- Quality Assurance
- Customer Service Query
- Injury
- Other Reason
- Near Miss
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Outcome of CCTV being viewed
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Is Follow up Action required, if so complete below section
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Follow Up Actions