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\par }}{\*\ftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1907761 \chftnsepc 
\par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1907761 \chftnsep 
\par }}{\*\aftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1907761 \chftnsepc 
\par }}\ltrpar \sectd \ltrsect\linex0\endnhere\pgbrdropt32\pgbrdrt\brdrthtnsg\brdrw60\brsp480 \pgbrdrl\brdrthtnsg\brdrw60\brsp480 \pgbrdrb\brdrthtnsg\brdrw60\brsp480 \pgbrdrr\brdrthtnsg\brdrw60\brsp480 \sectdefaultcl\sftnbj {\*\pnseclvl1
\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}{\*\pnseclvl5
\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang 
{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar\s22\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ab\af1\afs24\alang1025 \ltrch\fcs0 
\b\fs24\lang1033\langfe1033\loch\af1\hich\af1\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs28 \ltrch\fcs0 \fs28\insrsid16403045\charrsid13925139 \hich\af1\dbch\af31505\loch\f1 ACCIDENT / INCIDENT REPORT
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
Please fill out this form completely for any safety-related incident}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10299806 ,}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1  whether or not th}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 e incident resulted in injury. }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Complete the form as soon a}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 s possible after the incident. }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
In completing the form, provide as much detail as possible including time of occ\hich\af1\dbch\af31505\loch\f1 urrence, location, general physical conditions present, witnesses, and a}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 
\hich\af1\dbch\af31505\loch\f1 ny other relevant information. }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Use the bottom and back of this form to add detail, draw diagrams, etc.
\par 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 
\par {\pntext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 1.\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\sl480\slmult1\widctlpar\wrapdefault{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnstart1\pnindent360\pnhang 
{\pntxta .}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Volunt}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 
\hich\af1\dbch\af31505\loch\f1 eer n}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 ame}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
_______________________________________________________
\par {\pntext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 2.\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\sl480\slmult1\widctlpar\wrapdefault{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnstart1\pnindent360\pnhang 
{\pntxta .}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 D\hich\af1\dbch\af31505\loch\f1 epartment/p}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 osition____________________________________________________ 
\par {\pntext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10299806 \hich\af1\dbch\af31505\loch\f1 3.\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\sl480\slmult1\widctlpar\wrapdefault{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnstart1\pnindent360\pnhang 
{\pntxta .}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10299806 \hich\af1\dbch\af31505\loch\f1 Date and}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 
\hich\af1\dbch\af31505\loch\f1  t}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 ime of }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 in}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 cident ____}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10299806 \hich\af1\dbch\af31505\loch\f1 _}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 
\hich\af1\dbch\af31505\loch\f1 ________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 ___________________________
\par {\pntext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid16526563\charrsid10299806 \hich\af1\dbch\af31505\loch\f1 4.\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\sl360\slmult1\widctlpar\wrapdefault{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0
\pndec\pnstart1\pnindent360\pnhang {\pntxta .}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid10299806 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563\charrsid10299806 \hich\af1\dbch\af31505\loch\f1 
Specific location of incident __}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045\charrsid10299806 \hich\af1\dbch\af31505\loch\f1 ____________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid10299806\charrsid10299806 
\par }\pard \ltrpar\ql \fi360\li0\ri0\sl480\slmult1\widctlpar\wrapdefault{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 
\hich\af1\dbch\af31505\loch\f1  }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 ________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 
\hich\af1\dbch\af31505\loch\f1 ______________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par {\pntext\pard\plain\ltrpar \s16 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 5.\tab}}\pard\plain \ltrpar\s16\ql \fi-360\li720\ri0\widctlpar\wrapdefault{\*\pn \pnlvlbody\ilvl0\ls1\pnrnot0\pndec\pnstart1\pnindent360\pnhang
{\pntxta .}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid13925139 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af1\hich\af1\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Witnesses }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid13925139 \hich\af1\dbch\af31505\loch\f1 present}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
____________________________________________________
\par }\pard \ltrpar\s16\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 
\par }\pard \ltrpar\s16\ql \fi360\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13925139 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid13925139 \hich\af1\dbch\af31505\loch\f1 6. }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid10890751 \hich\af1\dbch\af31505\loch\f1  Description of incident (U}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1 se as much detail as possible, including}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16526563 
\hich\af1\dbch\af31505\loch\f1  diagrams}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10181104 \hich\af1\dbch\af31505\loch\f1 .)}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1  
\par }\pard\plain \ltrpar\ql \fi360\li0\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13925139 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 _________________________________________}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 _____________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par \hich\af1\dbch\af31505\loch\f1 _________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 ______________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid16403045 
\par \hich\af1\dbch\af31505\loch\f1 _________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 ______________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid16403045 
\par {\listtext\pard\plain\ltrpar \s16 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 7.\tab}}\pard\plain \ltrpar\s16\ql \fi-360\li720\ri0\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin720\itap0\pararsid10299806 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af1\hich\af1\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid16526563 \hich\af1\dbch\af31505\loch\f1 Cause of incident}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10890751 \hich\af1\dbch\af31505\loch\f1  (I}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16526563 \hich\af1\dbch\af31505\loch\f1 
nclude toys, objec\hich\af1\dbch\af31505\loch\f1 ts, people}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1 , e}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid13925139 \hich\af1\dbch\af31505\loch\f1 tc., and specify the items that }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10299806 \hich\af1\dbch\af31505\loch\f1    
\par }\pard \ltrpar\s16\ql \li360\ri0\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid10299806 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid13925139 \hich\af1\dbch\af31505\loch\f1 d}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid10299806 \hich\af1\dbch\af31505\loch\f1 irectly caused an}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1  injury}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10299806 \hich\af1\dbch\af31505\loch\f1  if applicable}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10890751 \hich\af1\dbch\af31505\loch\f1 .)}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 
\par }\pard \ltrpar\s16\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 
\par }\pard\plain \ltrpar\ql \li360\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\loch\af0\hich\af0\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
______________________________________________________________________________________________________________________________________________ 
\par \hich\af1\dbch\af31505\loch\f1 ____________________\hich\af1\dbch\af31505\loch\f1 ___________________________________________________
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 8. }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Injury}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10299806 \hich\af1\dbch\af31505\loch\f1 , if applicable, }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\hich\af1\dbch\af31505\loch\f1 caused by incident}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1  (Describe injury}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10299806 ,}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1  }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 such }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 
\hich\af1\dbch\af31505\loch\f1 as a sprained ankle, cut, }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10181104 \hich\af1\dbch\af31505\loch\f1 bruise, }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1 
etc.)}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1   ______________________________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1 
_________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1  
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 ___\hich\af1\dbch\af31505\loch\f1 
____________________________________________________________________ 
\par 
\par }\pard \ltrpar\ql \li360\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid10299806 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 
9. Actions taken to respond and resolve incident }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 _______________________________________________________________________
\par }\pard \ltrpar\ql \li360\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
________________________________________________________________\hich\af1\dbch\af31505\loch\f1 _______ 
\par \hich\af1\dbch\af31505\loch\f1 _______________________________________________________________________
\par 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10754270 \hich\af1\dbch\af31505\loch\f1 10.\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0\pararsid13925139 {
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10754270 \hich\af1\dbch\af31505\loch\f1  }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 System / process }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 improvements }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 to prevent future incidents }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 
\hich\af1\dbch\af31505\loch\f1 (D}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 e}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16526563 \hich\af1\dbch\af31505\loch\f1 
scribe preventative measures that could be taken to eliminate this risk}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1 .)}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\hich\af1\dbch\af31505\loch\f1  ___________________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10890751 \hich\af1\dbch\af31505\loch\f1 _________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 

\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par }\pard \ltrpar\ql \fi720\li0\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
_________________________________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 ___}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1  

\par }\pard \ltrpar\ql \fi360\li360\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid13925139 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
_______________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 _____________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par \hich\af1\dbch\af31505\loch\f1 _________________________________________}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 \hich\af1\dbch\af31505\loch\f1 _____\hich\af1\dbch\af31505\loch\f1 ______________________}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid16403045 
\par }\pard \ltrpar\ql \li0\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 
\par \hich\af1\dbch\af31505\loch\f1 Report completed by:  ___________________________________  Date:___________\tab 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid13925139 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid16403045 \hich\af1\dbch\af31505\loch\f1 Report reviewed by 
\par }\pard\plain \ltrpar\s16\ql \li0\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\loch\af1\hich\af1\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10754270 \hich\af1\dbch\af31505\loch\f1 church l}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid16403045 \hich\af1\dbch\af31505\loch\f1 
eadership:   _____________________________________Date:___________
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