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e <br /> APPENDIX E: Exposure Incident Form <br /> -OU Line Screening <br /> Exposure Incident Report <br /> Date of Incident: Time of Incident: Location of Incident: <br /> 'catentrell 'trafe+ctWas: terlals llnuolved <br /> Type source: <br /> Type: Source: <br /> Circumstances(work being performed,etc.): <br /> How Incident Was Caused(accident,equipment malfunctions,etc.): <br /> Personal Protective Equipment Being Used: <br /> Actions Taken(Decontamination,Clean-up,Reporting,etc.): <br /> Recommendations For Avoiding Repetition: <br /> Name of Person Completing Report: Signature of Person Completing Report: <br /> Title of Person Completing Report: Date Report Completed: <br /> 13 <br />