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APPENDIX B (Continued) <br /> What could have been done to prevent this injury/near miss? <br /> What body part was injured or could have been injured? <br /> If you were injured: <br /> Did you see a doctor about this injury/illness? Yes/No <br /> If yes, doctor name: <br /> Phone number• <br /> Date: Time: <br /> Were you hospitalized overnight? Yes /No <br /> If yes, name and address of hospital: <br /> Has this part of your body been injured before? Yes/No <br /> If yes, when? <br /> 10275-4 <br /> D U D E K B-2 June 2017 <br />