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Get Dangerous Occurrence Report Form

Ted in absence from work? YES (ATTACH STATEMENT) NO What time did he/she stop work? am/pm HSE STATUTORY REQUIREMENTS Is incident notifiable to HSE? (See Departmental Safety Arrangements) YES NO IF YES: HSE notified by phone? YES NO Anticipated duration of absence days HSE form F2508 sent? YES BY: NAME DATE If yes, did he/she do any work on the day of the incident after it happened? YES NO NO IF THIS FORM HAS NOT.

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