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Safety Incident and Near Miss Report

Date and time of near miss or incident
Year
Month
Day
Time
HoursMinutes
Property Damage?
Yes
No
Severity of incident or near miss (check all that apply)

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Safety Incident and Near Miss Report

Date and time of near miss or incident
Year
Month
Day
Time
HoursMinutes
Property Damage?
Yes
No
Severity of incident or near miss (check all that apply)
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