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Y <br /> 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 /> Work area/Job Class of employers: <br /> Nature of incident: <br /> Body part(%) affected: <br /> What work place condition, work practice, or protective equipment contributed to the <br /> 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 /> Page - 40 <br />