Workplace Health and Safety Electrical Incident Report Form

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Electricity Entity Incident Form

Form 1 V2.03-2006 Electrical Safety Act 2002
Note: Reporting a serious electrical incident or a dangerous electrical event is not an admission of liability by the electricity entity in respect to that incident or event.
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Notifier Details

* Notifier name:		* Notifier telephone no:
* Notifier email address:

Submission