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Injury Review Form

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Purpose of this form is to provide a follow up with regards to workplace injuries. It will ensure both Supervisor and Employee involvement in identifying the root cause of the incident (hazard, process or unsafe behavior) while developing srategies for prevention.

To be completed within 5 working days of incident

Please submit and print a copy for the employee and supervisor to file.

Thank you for your time and helping prevent future workplace injuries.
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