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Name and position of person reporting:___________________________________________
District/region: ______________________________________________________________
Incident date and location: _____________________________________________________
Refrigerator type: ____________________________________________________________
Incident summary (circumstances, source of the problem, temperature noted, times, etc.):
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Actions taken to fix the problem:
List of products and information:
| Item code | Item | Manufacturer |
Lot |
Quantity |
Price |
Total |
Stop!Watch® |
Instructions |
|---|---|---|---|---|---|---|---|---|