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Wolverine Builders Inc - Incident Report
Incident Date and time
Month
Day
Year
Time
:
Hours
Minutes
AM
Reported By:
Location
Incident Type
*
Injury
Near Miss
Property Damage
Other
Describe Incident
Persons Involved
Describe Injuries if applicable
Root Cause Analysis - What Caused the incident? (equipment failure, lack of training, negligence)
Steps Taken to prevent recurrence
1)
2)
Witness 1
Witness 2
Reporter Signature
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