Safety Hazard Report

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Safety Hazard Report
Report
Date:
Report No.
Reported by:
Recorded by:
Reporter Contact Info:
Recorder Contact Info:
Hazard
Location:
Equipment:
Malfunction:
Expiration:
Date:
Safety Code Violation:
Description of Hazard:
Corrective Action
Supervisor:
Safety Officer:
Recommended Action:
Required Cost:
Budget:
Action Taken:
Actual Cost:
Date Implemented:
Signature
Date

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