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REPORT AN INCIDENT...

Please use the form below to report an Incident to Geotech Drilling Services Ltd. Please note that some info is 'required' and is noted as such.

Reporting Date:   Required   Client:   Required
        Project:   Required
Incident Date:   Required   Geotech Employee(s):   Required
Time:   Required   Employee(s) Phone:   Required
Location:   Required   Witness:   Required
Description:   Required   Other Witness(es):  
        Witness Statements?  
Yes    No 
Incident Type:     Immediate cause(s):  
        Underlying cause(s):  
        Corrective action(s):  
Immediate   Interim   Final
             
IF INJURY/ILLNESS
  
IF PROPERTY DAMAGE
Shift:     Property Description:  
Age:     Estimated Cost:  
Occupation:     Actual/Potential Loss:  
Experience:     Type of Loss:  
Nature of Injury:     Description of Loss:  
             
RISK POTENTIAL IF NOT CORRECTED
  
   
Loss severity potential:  
Major    Serious    Minor 
       
Probable recurrence rate:  
Frequent    Occasional    Rare 
 
 
Thank you for your submission.

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