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Hazard Report Form

This form is to be completed where a hazard has been identified but no incident or injury has occurred. If incident or injury has occurred, please complete the Confidential Incident/Injury Report Form.

Name(Required)
DD slash MM slash YYYY

When was the hazard identified?

DD slash MM slash YYYY
Time(Required)
:
DD slash MM slash YYYY
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Max. file size: 128 MB.

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