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Voluntary Reporting/Hazard and Risk Assessment

Form Type (mark ONLY one option)


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Mandatory Occurrence Report (MOR) filled ?

For Voluntary reports ONLY, this information may be left blank (empty)

In your opinion, what is the likelihood that a similar occurrence can happen again? (Circle ONLY one answer)
What do you consider could be the worst possible consequence if this occurrence will happen again? (Circle ONLY one answer)
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