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Image #844,360
Uploaded by Dan Backslide Oct 08, 2014 at 09:19PM EDT
sesame street five nights at freddys bertstrips
Origin Entry: Five Nights at Freddy's
File type: png
Resolution: (300px x 380px)
File size: 213 KB
Moar:
![ACCIDENTNEAR MISS INCIDENT REPORT F22 Employee's name: Position: Gnrl. Securit If you are completing this form on behalf of another eoployee, please give your name: uard Department: Staff Details of the incident, Date of the incident: Nov, 15th. 1987 Location of the incident Describe the incident and what you were doing at the time.Animatronic Time of the incident: 1117HRs "Foxy" malfunctioned in lower jaw, and injured child's head. Emergency ser- vices were called to the scene were equipment or systems being used at the time? R AS 2 9 11 % Con Were work instructions being followed? Disobeyed Rule "Do not Were there any witnesses to the incident? (provide names and contact details) In your opinion was any person or system responsible for this incident? Did the incident result in: To whom did you first report the incident?Name: touch Foxy H [x] an injury [ anearmiss (with the potential to cause injury) Date: me: IR Details of the injury (if applicable) Describe the nature of the injury Parents are concerened of state of child, currently in comatose state. Cleanup crews required Was first aid treatment required? s Was medical treatment required? Recieved @ Hospital lf so, who was the doctor? The injury occurred: [on the way to work Ion the way bome from work [y] at work [ 1 other Lmployee s signature; Date: Nov. 17th, 1987 If there is insufficient room on this form to fully describe the details of the incident or injury, complete further details on the reverse side of this form, or attach an additional report Please lodge this form promptly with your Manager, who will inımediately lodge it with the Human Resources Manager and the Workplace Health & Safety Officer.](https://i.kym-cdn.com/photos/images/newsfeed/000/844/039/d72.jpg "Made by Foxy the Pirate Fox (OP)")
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Uploaded Oct 08, 2014 at 09:19PM EDT
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Dan Backslide
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