Laserfiche WebLink
0 <br /> ACCIDENT AND ILLNESS IN'VESTIGATION REPORT(Coutinued) <br /> Corrective ciao {s)Taken by Unit Reporting the Accident <br /> Corrective Action Still to be Taken(by who and when): <br /> Name of Tetra Tech employee the injury or illness was first reported to: <br /> Date of Report: Time of Report: <br /> I have reviewed this investigation report and agree,to the best of my recollection,with its contents. <br /> Printed Name of Injured Employee Telephone Number <br /> Signature of Injured Employee Datec <br /> The signatures provided below indicate that appropriate personnel have been notified of the incident. <br /> Title Printed Name Signature Telephone Number Date <br /> Project or Office Manager <br /> Site Safety Coordinator <br /> Ttlisf=-oontains Information fdatIng to employee health and must be used In a manner dmt protects the confidenfiality of <br /> em : the <br /> oyee to the extent possible mfile te informabon is being used for occup2�onal sq%ty and teaffl putposes. <br /> Form AR-I Pago 3 of 4 <br />