Unsafe Condition Investigation FormThe goal of the investigation is to reduce hazards and prevent recurrence. UCR Number: * This is the submission result number from the Unsafe Condition Report Form. Acknowledged By: * Person who opened the report. Investigation Assigned To: * Person conducting the investigation. Findings: * Details of the findings of the investigation. Overt cause: * Determined surface cause of the underlying issue. Root cause: * Underlying cause of issue creating overt cause. Potential to cause: * Injury Illness Property Damage Interference with class schedules Interference with staff's ability to perform work Check all that apply. Interim Measure: * Temporary measure until permanent fix is in place. Prevention of recurrence: * Details of permanent fix of issue. Training required? * Yes No Is training required as part of prevention? Training Topic What kind of training topic? Action(s) assigned to: Secondary email of person required to do actions of prevention. Action(s) assigned to: Email of person required to do actions of prevention. Action due date: * Year20222023202420252026 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Date action is due. Individual to verify action: * Name of individual to verify actions taken. Date verified: * Year20222023202420252026 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Date action was verified. Notes: Any additional notes. CAPTCHA This question is included to prevent automated spam submissions; it is not presented to logged-in users. Submit