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,Site Safety and Health Plan <br /> Wayne Perry, Inc <br /> Immediate Notification of HES Incident to the Corporation <br /> Use this form when making notifications to Corporate Emergency Response Staff: Call(800)883-0352 or(714) <br /> 826-0352 <br /> BUSINESS UNIT: LOCATION: <br /> PERSON MAKING LOCAL DATE AND TIME OF CONTACT NUMBER: <br /> NOTIFICATION: NOTIFICATION: <br /> TYPE OF INCIDENT: <br /> ❑FATALITY ❑ SPILL/RELEASE <br /> EJ INJURIES ❑NATIONAL/SIGNIFICANT LOCAL NEWS COVERAGE <br /> ❑OTHER SIGNIFICANT HES INCIDENT <br /> LOCAL DATE AND TIME OF INCIDENT: <br /> DESCRIPTION OF INCIDENT: <br /> INJURIES: <br /> ACTIONS TAKEN OR PLANNED: <br /> ASSISTANCE REQUIRED: <br /> MEDIA ATTENTION: <br /> OTHER INFORMATION: <br /> CORPORATE TEAM MEMBER TAKING REPORT: <br /> Incident Free Operation Page 31 of 68 <br />