TGA Hood Cleaning
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Injury Report
(Must fill in all fields. If not applicable, type none)
Employee Name
Job Title
Body Part / Parts Injured
Date of Injury
Location of Injury
Detailed Description of Injury
Did you see a Doctor
Yes
No
Please describe preventative measures taken moving forward?
Has body part ever been injured in the past ?
Yes
No
If Yes, Please Explain:
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