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'I d Ro# <br />-PERATORS Pilot/ Flying -7 - Lodi #617 Veeof 2 <br />UST Svstem Alarm Response Log <br />Complete all sections that apply. The "Entry V box is to note the consecutive 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 <br />the alarm. Check 'Called In' If that Is the case. Otherwise check "Self -managed." Be sure to check the 'Resolved' box when the condition triggering the alarm has been addressed. Until then, the Issue should be checked as 'Pending! <br />The goal of this form is to record environmental alarms plus their resolutions. Resolutions should be specific, such as 'removed rairmater" or "replaced sensor rather than vague such as 'told manager" or 'cared contractor." If a contractor work order <br />provides more deter, be sure the record the work orderk Whoever completes an entry should note their name in the "Recorded By" box. Wrille Legibly and accurately and with enough detail to explain the alarm and the resolution without leaving out <br />Important details about the incident The space provided should be sufficient In most cases, but if is not attach a separate piece of paper. <br />Entry <br />Entry # <br />Entry# <br />0 Self -managed '61fCalled ink -1 <br />Date <br />Time <br />--Alarm Screen Redding, Incident Details and Initial Response Ste s) Taken Recorded By: <br />Date <br />Time <br />Alarm Screen Reading, <br />Date <br />Time <br />Follow Up Step(s) Taken to Resolve Alarm Trigger Recorded By: <br />cll-t"/ <br />V -,N" <br />Current Status <br />Cause of Alarm Was Product Released?) I Comments and Further Actions Necessary <br />r-3 Pending 0 Resolved <br />13 No release q Contained release 0 Uncontained release <br />'%§elf -managed <br />of <br />0 Called in <br />L <br />Alarm Screen Reading, Incident Details and Initial Response Ste (s) Taken Recorded By: <br />Date <br />Time <br />Alarm Screen Reading, <br />Incident Details and Initial Response Ste s) Taken <br />Recorded By: <br />Follow Up Step(s) Taken to Resolve Alarm Tri er Recorded By: <br />cll-t"/ <br />V -,N" <br />Current Status <br />Date <br />Time <br />Follow Up <br />Step(s) Taken to Resolve Alarm Trigger <br />Recorded By: <br />til k <br />;J <br />Current Status <br />Cause of Alarm <br />Was Product Released?) / Comments and Further Actions Neces*ary <br />0 Pending <br />0 Resolved <br />0 No release 0 Contained release <br />13 Uncontained release <br />M I <br />qLdf-managed 0 Called in <br />Date <br />Time <br />Alarm Screen Reading, Incident Details and Initial Response Ste (s) Taken Recorded By: <br />'7 <br />T. 247 <br />L <br />Date <br />Time <br />Follow Up Step(s) Taken to Resolve Alarm Tri er Recorded By: <br />V -,N" <br />Current Status <br />Cause of Alarm (Was Product Released?) I Comments and Further Actions Necessary <br />13 Pending P -solved <br />0 No release 0 Contained release 0 Uncontained release <br />Ll <br />E <br />