Lir
Lir
QA/QC Lab
Laboratory investigation report
Date: 1-14-2016
Rev: 0
Chemicals Incorporated
Prepared by: Hima Konuru
QA/QC Lab
Laboratory investigation report
Date: 1-14-2016
Rev: 0
Report Number
Open date:
Closing Date:
Report Prepared by
Person(s) involved
Date discovered
Fatal
Major
Minor
Yes
No
Yes
No
Frequency of occurrence
Chemicals Incorporated
Prepared by: Hima Konuru
QA/QC Lab
Laboratory investigation report
Actions suggested:
Date: 1-14-2016
Rev: 0 , Continued
Chemicals Incorporated
Prepared by: Hima Konuru
QA/QC Lab
Laboratory investigation report
Date: 1-14-2016
Rev: 0, Continued
Lab Personnel (present when the incident occurred and or involved with the incident):
Name
Signature
Date
__________________________
___________________________
________
__________________________
___________________________
________
__________________________
___________________________
________
__________________________
___________________________
________
__________________________
___________________________
________