Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 4 57 of 53 8 Doc u m e n t Identif icat ion F R M 011 P age Nu m b e r 2 of 3 Doc u m e n t C r e ation Dat e F e bru a r y 10 2016 Im p le m e n tat ion Dat e F e bru a r y 10 2014 R ECOMMEND AT I ON S I dent i f y any cor r ec t i v e a c t i ons t ha t hav e be en t ak en w i l l be i m pl em ent ed t o p r e v ent si m i l a r i nc i den t s R ec o m m e n d ed C o r r ec tiv e A c t io n Ass i g n ed T o E s ti m a ted co m p let io n d ate A ct u al co m p d ate PRO PE RT Y D A MA G E Fil l t h i s se c t i on i f t he i nc i den t con t r i bu t ed t o e qui pm ent pr o per t y dam ag e I dent i f i c at i on o f M ac h i ne r y Pro per t y D am a g ed N at ur e of D am ag e Est i m at ed Co st of R ep ai r o r R epl a ce m ent C os t A ct ua l C os t of R epa i r o r R epl a ce m ent C os t O bj ec t Eq ui pm ent I nf l i ct i ng dam a g e R EP ORT R EV I EW B R AN C H MA NA GE R or D ES I GN AT E T h is s ec tio n s h all b e co m p leted b y t h e B r an ch Ma n a g er o r its d esig n a te o n ce r ep o r t h as b ee n r ev ie w ed b y h i m A c k n o w led g i n g th is r ep o r t c o n f ir m s th at t h e B r an ch Ma n a g er o r its d esi g n ate i s a w ar e o f t h e in c id en t a n d w i ll en s u r e th at co r r ec tiv e ac tio n s h av e b ee n o r w ill b e i m p le m e n ted in a ti m el y m a n n er D A T E O F R EV I EW N A ME O F B R A N C H M A N A G E R O R D E SI G N A TE SI G N A T U R E O F B R A N C H MA N A G E R O R D E SI G N A TE B R A N C H MAN A G ER or D ES I G N A T E R EC O MM EN D A T I O N S J o i n t H ea l t h Saf et y Com m i t t ee J H SC o r Safet y Rep re s e n t a t i v e S R Re v i ew E ac h in cid en t s h a ll b e r ev ie w ed at t h e s a f et y m ee t in g W o r k er s a f et y r ep r ese n tat io n s h a ll si g n o f f to ac k n o w le d g e th at i n cid en t h as b ee n r ev i e w ed an d s u p p o r ts co r r ec tiv e ac tio n s i m p le m en ted DA TE O F R EV I EW NA ME OF J HSC MEMB ER O R EMP L OY EE S I GN AT URE O F J HSC MEMB ER OR S R