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Any Safety Concerns
Any Environmental Concerns
Any Community Concerns
Number of Personnel
Corrective Actions at time of inspection
List corrective actions outstanding from previous visit
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
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