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.f <br /> FORM 308 <br /> ACCIDENT REPORT <br /> ti Note: To be complete only for representative of CH2X XIL'„ <br /> INC. <br /> Project NO. - <br /> Prolect:� --_ <br /> Employee No._ <br /> Injured Emplayee: <br /> Tine: a.m. P.M. <br /> Date Injured: <br /> Last Day Worked:__� <br /> - <br /> Date Reported: <br /> Date Returned: <br /> � <br /> to ee Return to Work?'Did �P Y <br /> V Where Accident Occurred: <br /> Witnesses: <br /> Work Performing Wi sn Injure:::--------- �- <br /> Y . <br /> Lind and Extent of Injary: <br /> Name & Address of Doctor/Hospital: <br /> , <br /> Description of Accident: <br /> Was There Equipment Malfunction? YES --NO <br /> 0 <br /> Describe Damage to £q'lipment or Property: <br /> �------- <br /> Unsafe Condition or Act Causing Accident: <br /> r <br /> iiiiiiiiii��illinmo min <br /> is <br /> �' . .. <br />