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ACCIDENT , INJURY , AND ILLNESS INVESTIGATION <br /> California Petroleum Equipment , Inc . <br /> P .O. Box 9364 <br /> Fresno , CA 93792 <br /> (209) 276- 1881 <br /> Date of incident : <br /> Name( s ) of affected employees : <br /> 6 <br /> Work area/Job Class of employees : <br /> Nature of incident : <br /> a•1 <br /> Body part(s) affected : <br /> What work place condition, work practice , or protective equipment <br /> contributed to the incident : <br /> ' Was a "Code of Safe Practice" violated (yes/no) : <br /> If so, which one : <br /> What corrective actions will prevent another occurrence : <br /> -. Will an add ' l "Code of Safe Practice" be needed (yes/no) : <br /> If so, explain : <br /> >1 <br /> Was the unsafe condition , practice, or protective equipment <br /> problem corrected immediately (yes/no) : <br /> If not , explain what has been done to assure correction : <br /> Page 30 <br />