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m��R�T®RS Pilot/ Flying .1 -Lodi #t517- Ve �_ Root OiSOUTHERH UEIrOAH1A &ST $rslem Alarm Response Log Complete all sections that apply. The "Entry #" box is to note the consecutive number of each entry (ff more than one is recorded in a month). The contractor Infonnatton needs to be added only If a contractor is called upon to resolve the alarm. Check "Called in" N that is the case. Otherwise check 'Sett -managed ° Be sure to deck the "Resolved° box when the condition triggering the alarm has been addressed. Until then, the issue should be checked as "Pending." The goal of this form is to record environmental alarms plus their resolutions. Resolutions should be specific, such as "removed rainwater" or "replaced sensor rather than vague such as `told manager° or "called contractor," If a contractor work order provides more detail, be sure the record the work order #. Whoever completes an entry should note their name In the "Recorded Br box. Write legibly and accurately and with enough detail to explain the alarm and the resolution without leaving out important details about the incident. The space provided should be sufficient in most cases, but tt is not, attach a separate piece of paper. Eh� �n- FEE n -hr y #: • • se - s • • e. • i • ❑ Self -managed ❑ Called in Date Time Alarm Screen Re in , Incident Details and Inial( Response Ste (s) Taken Recorded By: Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded By: /v'Z / , �� ./�/rr � /r•t..f• ,.Cf /ti✓c-%�J n t' /ter IG : �/`-.it/ f L.�j Current Status Cause of Alarm (Was Product Released?) / Comments and Further Actions Necessati____ ❑ Pending 13 Resolved Pio release ❑ Contained release ❑ Uncontained release ❑ Self -managed ❑ Called in I., _ .� „,�� ,�1, u Date Time Alarm Screen ReaOM Incident Details and InitialJies onse Step(s) Taken Recorded By: Date Time Follow Up Ste (s) Taken to Resolve Alarm Trigger Recorded By: Current Status ,-,-/Cause of Alarm Was Product Released? / Comments and Further Actions Necessa�/'-� ❑ Pending ZrReSolved EINo release ❑ Contained release ❑ Uncontained release - -T. -1 f ® 0 ❑ Self -managed ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response Ste (s) Taken Recorded By: Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded By: Current Status Cause of Alarm (Was Product Released?)1 Comments and Further Actions Necessary ❑ Pending 0 Resolved ❑ No release 0 Contained release ❑ Uncontained release v