Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Explain in detail any "Safety Concern" or "Near Miss" (include what, when, and where)
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Include All Employees Present.
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Photographs of situation observed, damage sustained, etc.
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Location
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Your suggestions on how to improve this situation would be greatly appreciated: (Optional)
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I have corrected the "Safety Concern" / "Near Miss"
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How has it been corrected?
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Photographs of corrected items.
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Date & Time Reported
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Name of individual reporting
