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  • Incident Report Form

  • I witnessed violations of the following checklist items:

    • 1. Daily room cleaning and disinfection  
    • 2. PPE and social distancing for ALL 
    • 3. Test and screen to prevent illness 
    • 4. Rapid response to suspected outbreak 
    • 5. No retaliation for workers who speak out about safety 
    •  -
    • 6. Other 
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