Title Page
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Time and date of incident
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Employee's Name
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Contact number
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Name of manager notified
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NG employee or contractor
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Reported by
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Responsible department
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If other please specify
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Incident address
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Document No.
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Brief description of hazard
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Location of hazard
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Actions taken
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Photos
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Brief description of hazard
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Location of hazard
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Actions taken
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Photos
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Brief description of hazard
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Actions taken
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Location of hazard
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Photos
