Doc No.

: HSE/FRM-32

ACCIDENT INVESTIGATION REPORT Rev.No.: 02

Date: JUL 23, 05
Page: 4 of 4

Sr # Corrective Action Responsibility Target date

Sr # Preventive Action Responsibility Target date

Prepared by Incharge Site HSE Reviewed by SM/PM

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Date : Date :

CC : Incharge PP&A, BA Representative and Head QHSE.

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