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Please complete this form for any near-miss or incidents.
If you have an injury, report it using the Company Nurse Injury Hotline at 1-888-770-0928
If Urbandale or private property or equipment was damaged, notify your supervisor immediately.
Please provide specific factors and examples
What could have been the result?
A copy of this form, along with any follow-up recommendations will be sent to your Department Director. If necessary, the Safety Incident Prevention Team may contact you or your supervisor to gather more information as part of their on-going effort to make Urbandale a safer place to work.
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