APPENDIX 8-1

SAMPLE FORM FOR TRACKING HAZARD CORRECTIONS

Instructions: Under the column headed "System," note how the hazard was found. Enter Insp. for inspection, ERH and name of employee for employee report of hazard or Acc. for accident/incident investigation.

Under the column headed "Hazard Description," take as many lines as you need to describe the hazard. In the third column, provide the name of the person who has been assigned correction responsibility. In the fourth column, list any interim action to correct the hazard and the date performed. In the last column, enter the completed corrective action and the date that final correction was made.

TRACKING HAZARD CORRECTIONS

SYSTEM HAZARD DESCRIPTION ASSIGNED TO: INTERIM ACTION WITH DATE COMPLETED ACTION WITH DATE