Kansanshi Abnormalities

• Site conducted:

• Conducted on:

  Date
• Location:
  Address

• Prepared by:

• Description of abnormality:

• Pictures:

  Media

• Particulars of the responsible supervisor for the area:

• Is this abnormality due to a criminal action?

  Yes

  No

  N/A

• Was this act reported?

  Yes

  No

  N/A

• To whom was the criminal act reported to?

• Date & time of reporting:

  Date

Reported by:

• Name & surname:

• Date & time:

  Date

• Signature:

  Sign