Laserfiche WebLink
<br />CITATION/ORDER DOCIIMENTATION <br />DATE L~ ~1~ /r~ CIT/ORD No. //~~f~~~ EVENT No. ~/,S'2 ~/3 <br />TIME ~- 2O CONTRACTOR ID No. ~ <br />...................... <br />VIOT:i'iTT02~1 <br />............. <br />DESCRIBE: CONDITION/PRACTICE/HAZARD/LOCATION ,u~ ~c~« ~/~~r ~ ~` y^~~ <br />[ <br /> <br />.:........................ . <br />tl12~a:T2'Y:? <br />NoLikelihood () Unlikely (~ Reasonably Likely () Highly Likely () Occurred ( ) <br />Justification: ~ y~l __dG e~~rio~4 L~1 ,~ !i/lC~ - <br />No Lost Workdays () Lost Workdays or Restricted Duty () Permanently Disabling () Fatal,( <br />•Persons affected: ~~ <br />HEaLICiENCE <br />None () Low () Moderate ~f High () Reckless Disregard ( ) <br />Justification: ~ ~ ~ ~ err ~.ui~~ ~ /rrd ~~_,~~~crf~~~ <br />~/~ .s..tG ~/ <br />Area/Equipment (Orders): <br />Page I of ~ <br />MSHA Form 4000-49E, Aug. 93 (rev~setl) <br />. V. s. 4ov[grvu[nT qql Xrl rv4 oFrlcL: 1pp3-]09.51! <br />