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Check Out The HIM —Sled Safe <br /> ❑ Any maintenance follow-up required: <br /> ❑ Communicated/maintenance requirement and deadline for completion. <br /> I <br /> I <br /> ❑ Inspection required to confirm that required action has been completed. I <br /> I <br /> 1 <br /> ❑ Preventive actions taken immediately: I <br /> 1 <br /> i <br /> 1 <br /> 1 <br /> ❑ Preventive actions to be completed. Describe: 1 <br /> 1 <br /> i <br /> Urgency: 0 today 0 tomorrow 0 within 2 days 0 within 7 days. 1 <br /> 1 <br /> 1 <br /> Comments: 1 <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> _ 1 <br /> Signature: 1 <br /> Submitted to: <br /> Date: 1 <br /> 1 <br /> 1 <br /> Appendix A—Sample Inspection Report Page 30 1 <br /> 1 <br />