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69 <br /> <br />FORM SP-3 REPORT OF AN UNSAFE CONDITION <br /> Instructions to employees: Briefly describe the location and nature of the unsafe condition. Identify any possible <br />corrective actions. Sign/date the report. Submit report to your immediate supervisor. <br />To be completed by employee reporting the unsafe condition <br /> <br />Location: <br /> Describe unsafe condition: <br /> <br /> Suggested corrective actions: <br /> <br /> Reported by: Date: <br /> To be completed by work unit supervisor <br /> <br />Received by: Date: <br />  Suggested corrective actions taken <br /> Referred to safety committee <br />Comments/actions taken: <br /> <br /> To be completed by safety committee <br /> <br />Date reviewed/acted upon: <br /> <br />Recommendation of safety committee: <br /> <br /> <br /> <br /> Corrective actions initiated by safety committee <br /> Corrective actions referred to work unit manager for review/initiation <br /> To be completed by work unit manager <br /> <br />Date acted upon: <br /> <br />Actions taken: <br /> <br />