Document 6BykdaB5mq41vdKB8mK06gpmR

unSafe ORIGINATOR condition report Describe the condition WHAT is the condition? /ts&es/'as WFL N? 3167 YfeqtojLi ff- ^a/Aa/9 aJ/ 0 / /P- / Employee fills out this section describing the unsafe condi tion. Be sure to sign name and give unit, shop or area. WHERE is the condition located? (Be specific--building, floor, etc.) . VV>f 2>ec_ ~7Z, ~7TuJ/*-____ ('/Wt/J./y The report is then given to your Immediate Supervisor and the WHITE (top) COPY sent to the Safety Dept. WHY do you consider this condition unsafe? 4/kl>eslc /a//,*,* // ffi/cr a/o/Jf'Aj4 -f'r9fuAtc(___ 6_jJ_--fX> y ----------------- Pe*f/---------------------- (' 'H)erf HJat/tS/vpi ____ _ -------------------------------------------------------------- - - rrro-.-^s.; The Immediate supervisor uses . .this section for his comments: regarding the above . de scribed condition. He then gives the report to his De spoilment .Head.: DEPARTMENT HEAD The Department Head ..trees : this section for Ills comments . * regarding the corrective action taken ori-disposition on the reported condition. , " .L On completion- he; routes the "' copies os specified below." Name _______ Deportment js Do*8 ' Lo ~ F */ Comments: (Corrective action taken or recommendations) * ' JtXy f LX4/J&P Klsc f Slsi 1 >*->I s Vjls/j Ca . _>-( -tVC-'Hjgitf.. T/LA XX- .<;? Supervisor *- J/i * rD\_a.t_e. ir in:. fJti CommQenltls^:l - - -v , i fh<r UC& ha.r he***, \t jkis l,nc ?k*J tL>q ' 1 1hauticsSj 3/txm kui*^ 'ZaJujws, es-j df- ;rtJU OXU /^cv t f 3)lxjhst ; 44. /etoWjT !*j zriXi^r kill. Ci+Hcs*iiJ '&> UlC. 4 t>)W/yj arsj frv *^-7^ Cavfcb/<t^ tV >in i _LAt>r n U'l / of _*L .........--_-- --------------------------........................ ................. ...................-- /H 3^c.:. >*:'< f~h* C > ccoommpp,L L 4>iJ 'H/ak*/ 7. fijci Canary--Dept. Head retains for file. Pink--To Originator of Report through his Supervisor. Department Head UCC 001995 Date