Information
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Document No.
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Safety Investigation
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Project Name and Number
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Conducted on
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Prepared by
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Location
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Personnel
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What prompted this investigation?
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Who reported the safety violation or concern?
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Describe the safety violation or concern?
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Add pictures is applicable
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Add drawing to help explain the concern if necessary
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Insert the names and phone numbers of all witnesses:
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What steps have been taken to mitigate the situation until the investigation is complete?
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Name of person making report
