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Get Wa F416-093-000 2006-2024

Accident date Time of accident Inspector ID Employer Employer Nature of occurrence I (was, was not) in the near vicinity of the accident when it happened. If near vicinity, list names of those persons you actually saw in the vicinity at the time of the occurrence. If you were not in the area when the accident occurred, but in another pertinent area, please give your location and the names of the persons you saw, or believe were present, in your area. I (am, am not) a supervisor of the inju.

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