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APPENDIX B (Continued) <br /> Contributing Causes <br /> Was training provided to insured regarding causes of accident? Yes/No <br /> Was training adequate to address hazards and proper controls? Yes/No <br /> Were supervisors, leads, and managers observing work habits to assure Yes/No <br /> that training was being followed, and holding people accountable? <br /> If applicable, was personal protective equipment adequate? Yes/No <br /> Was equipment failure or condition an issue? Yes/No <br /> Other: <br /> Corrective Actions and Responsible Parties <br /> Corrective Action Responsible Party <br /> Acknowledgement of Corrective Action Completed: <br /> Supervisor(Please print) Signature Date <br /> 10275-4 <br /> D U D E K B-5 June 2017 <br />