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y <br /> Was the unsafe condition, practice, or protective equipment problem corrected <br /> immediately (yes/no): <br /> If not, explain what has been clone to assure correction: <br /> What temporary measures have: been taken to prevent reoccurrences of incident <br /> Will the inspection checklist lir the area require modification w prevent reoccurrence <br /> (yes/no): <br /> If so, explain what will need to be, added: <br /> Signature of Investigator Date <br /> Responsible person for corrective actions: <br /> Copy of this report received by the above parson on (date): <br /> Responsible person 1'or corrections Date <br /> Management approval: 0 <br /> Page - 41 <br />