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URE TO FOLLOW INSTRUCTIONS OR PROCEDURES FAILURE TO USE PPE IMPROPER LIFT/CARRY MISUSE OF TOOLS/EQUIPMENT UNSAFE BODILY POSITION WEARING IMPROPER ATTIRE HORSEPLAY INATTENTION TO FOOTING OR SURROUNDINGS REMOVING SAFETY DEVICES UNSAFE SPEED FAILURE TO IDENTIFY A HAZARD NO UNSAFE ACT OTHER Fax: (805) 460-0286 Email: SIPE slosipe.org 7455 Morro Road, Atascadero, CA 93422 PLEASE FAX, EMAIL, OR MAIL A COPY OF THIS REPORT TO SIPE WITHIN 7 BUSINESS DAYS PAGE 2 OF 2 SUPERVISORY RESPONSIBILI.

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