COMPLIANCE INFO_2013-2016 - Laserfiche WebLink

Home Browse Search

.,PERATORS Rlotl/ J — Lodi #617-t 'II SysWm Marm ResponseN Month: II Year: .' Complete all sections that apply. The 'Entry #" box is to note the oonsecutive number of each entry (if more than one is recorded in a month). The contractor information needs to be added only if a contractor is called upon to resolve Rev. 081141 the alarm. Check "Called in" if that is the case. Otherwise check "Self -managed." Be sure to check the 'Resolved" box when the condition trggerl ng the alarm has been addressed. Unth 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 rote their name in the'Recorded By" 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 if is not, attach a separate piece of paper. Entry #' En - Self -managed ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response Ste (s) Taken Recorded BY: Uit 77) i J !. �k ��_ 1'��L �. 'f`a. l `�\.��' �V t `.;h. _�� 1� / �l. ll I ��.' i•L{^�� it.•� �1`,l . / '.. D to Time Follow Up Step(s) Taken\t61 Resolve Alarm Trigger Recorded By: Follow UpvS't'ep s Taken to Resolve Alarm Tri er Recorded By: 6 2� : ��vv� Current Status Cause of Alarm as Product Released? / Comments and Further Actions Necessary ❑ Pending �esolved No release ❑ Contained release ❑ Uncontained release ❑ Self -managed ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response Ste s) Taken Recorded By: j Z� 04: I� �i N4A J� � y to [ Date Time Follow UpvS't'ep s Taken to Resolve Alarm Tri er Recorded By: 6 2� : ��vv� , a �S ,J+I'+M cf t Gt t� tit W to AS UM US 61"hi of p7S' .S N.b,nES pnl Current Status Cause of Alarm Was Product Released? / Comments and Further Actions Necessa ❑ Pending Poesolved tMo release ❑ Contained release ❑ Uncontained release A - • • • • 0 • • ® • f ❑ Self -managed ❑ Called in Date Time Alarm Screen Reading, Incident Details and Initial Response to s Taken; Re rded B { S Date Time Follow Up Step(s) Taken to Resolve Alarm Trigger recorded B Current Status Cause of Alarm (Was Product Released?)/ Comments and Further Actions Necessary 0 Pending 0 Resolved 0 No release 0 Contained release ❑ Uncontained release