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Site Health and Safety Plan <br />19133 East Liberty Road, Clements, California <br />August 16, 2022 <br />Page 43 <br /> <br />Sharp Environmental Technologies, Inc. <br />18. SUPERVISOR’S ACCIDENT INVESTIGATION <br />(To be completed by employee’s supervisor or other responsible administrative official) <br />Location where accident occurred Employer’s premises: Y  N  <br /> Jobsite: Y  N  <br />Date of accident or illness <br />Who was injured?  Employee <br /> Non-employee <br />Time of accident AM  <br /> PM  <br />Length of time with firm Job title or occupation Dept. normally assigned to How long has employee worked at job <br />where injury or illness occurred? <br />What property/equipment was damaged? Property/equipment owned by: <br />What was employee doing when injury/illness occurred? What machine or tool was being used? What type of operation? <br /> <br />How did injury/illness occur? List all objects and substances involved. <br /> <br /> <br /> <br />Part(s) of body affected/injured? Any prior physical conditions? If so, what? <br /> Y  N  <br />Nature and extent of injury/illness and property damaged (be specific) <br />Supervisor’s corrective action to ensure this type of accident does not recur: <br /> <br /> <br /> <br />Was employee trained in appropriate use of personal protective equipment/proper safety procedures? Y  N  <br />Was employee cautioned for failure to use personal protective equipment/proper safety procedures? ... Y  N  <br />Did employee promptly report the injury/illness? ............................................................................................ Y  N  <br />Is there modified duty available? .......................................................................................................................... Y  N  <br />