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OSHA METHOD- 330 Incidents - 29 Minor Injuries-1 Major or Loss-Time Accident

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? () (Elimination, substitution, Engineering Control, Administration, PPE)

Name Of Observer

Emp No

LocationDetails of the Dangerous / Near Miss :

Suggestions By the Observer : Reported to

Ingestion by

Reviewed By Possible Actions :Corrective Action:

Time Line :

Review by Management :

Awards / Rewards for Observer :

Near Miss / Dangerous Occurrence Report S.NO:

Date :