The safety resources on this website (including blog articles, templates, checklists, safety meetings, and any other resource) are based on general best practices and should not be relied on as a sole source of guidance for your specific company and work situation. Incident reports aren’t created for the purpose of finding out who’s to blame. You may also like, The first thing that you need to do when incidents happen is to get the incident report forms that are used by your organization or business. Feel free to browse through our list of downloadable examples for document guides. USE THIS REPORT TEMPLATE . While you should always document injuries requiring first aid internally, you typically don’t need to add them to your Form 300A or other regulatory reporting. This portion of the report can be the most difficult part to write. John was taken to a nearby hospital and a fracture to his wrist was confirmed. A Detailed Incident Report Provides Investigators a clear picture of what happened on-site. You may also see management report examples. 2. Not ready to go mobile yet? Quality assurance. Simone said that he simply lost his grip, but Williams said he felt that the tool may have been ‘swung’ before dropping. For Accident Incident Reports. There are extensive incident report forms that are used by corporate establishments while there are also basic and short ones that are developed by organizations for the purpose of simple reporting and documentation. We provide this template to help professionalize the way you are working. This Incident Report Form will help you provide the necessary information needed to report the incident. We ask that you return the driver’s name to us for use in our monthly roll-up reports. Hence, listing all the facts that can support the incident’s occurrences is necessary to be included in the document. It provides a detailed description of what actually happened upon the occurrence of the incident. Here’s an incident report sample description of a slip or fall resulting in a fracture, written as a narrative: “On Friday afternoon, February 3, 2019, at 2 p.m. in ABC Shipping Co. located in 13th Avenue, Applewood, one of the warehouse workers (John Keegan) slipped and fell while carrying heavy (85 lbs) inventory. While staff should be held responsible (as stipulated by company policy) when they knowingly endanger themselves others, the report should focus on improving workplace safety. This will help you specify all the necessary information about the incident since there are already predetermined questions in the document. An example of a reoccurring incident is when one employee keeps behaving in a manner that causes his coworkers to be bothered, which then negatively affects the workflow. You could write incident report templates for different purposes and choosing the right format could help you make effective ones. In addition, if you’re rushing through the report to “just get it done,” you may miss out on important details or lack clarity in wording. The file features original suggestive sections including incident, date, time, page number, location, name, and details. Details. Williams returned to work within a half hour. Incident Reports are used as a basis for the investigation of such events. Businesses can use this IT incident report template to report incidents such as data breaches, privacy violations, viruses, and denial-of-service attacks. After completing your report in Safesite, you may immediately alert key personnel, tag other users, and create follow-up safety actions. After documenting the incident, you may have legal reporting requirements. Your company’s incident report form should make it easy to record the details of a workplace accident. Below are some sample incident report formats for three common types of workplace accidents. Here are some of the vital elements to include in your description of the incident: Though the details above seem like a lot, mentioning them in the incident report paints a more accurate picture than glossing over the incident. A police report is an important document stating a record of a criminal incident, such as assault, identify theft, or robbery, for example. Available in A4. By continuing to visit this site you agree to our use of cookies. You may also like sample activity reports. This way, you can already have the list of details that you need to include in the report. A workplace incident report is a document that records any type of incident that happens in the workplace, such as an employee injury, an accident, or damage to equipment. Improve your incident reporting process by using a digital reporting tool, like Safesite, that integrates alerts and hazard resolution. Safesite Solutions, Inc. disclaims all liability (except for any liability which by law cannot be excluded) for any error, inaccuracy, or omission from the information contained in the resources hosted on this website and any loss or damage suffered by any person directly or indirectly through relying on this information. Depending on your company policies and regulatory body, you may be legally bound to complete an incident report within a given amount of time. We'll give you tips on how to write a Detailed Incident Report in Microsoft Word using our Ready-Made Incident Report Templates. An incident report needs to include all the essential information about the accident or near-miss. Compiled here is a list of Incident Report Forms covering a variety of situations. A second possible cause is the condition of John’s PPE, specifically his boots, which are very worn in certain places. The root cause is believed to be the unavailability of a hand truck or pallet jack. used by corporate establishments while there are also basic and short ones that are developed by organizations for the purpose of simple reporting and documentation This can help you identify the incident occurrences more clearly. Hence, you have to be aware of the fact that the content of the incident report will be scrutinized to ensure the validity and precision of its content. This will help you to be more observant. From tagging and removing damaged equipment from service to safely dismantling corrupted structures, your incident reporting process is not truly complete until you resolve the danger. You may also like, Do not be vague. For example, the ladder capacity is 250 lbs and the victim was hoisting 300 lbs. We suggest you to use incident report writing examples as your references as long as you will be specific and observant with the following: The layout of an incident report can actually affect the flow of the document’s discussion. With this, you have to consider not only the content of the document but also on how all the details are collated or put together. We’ve also got a comprehensive guide to general report design if you want to dig a bit deeper into the topic. Accident Incident Report Form Example. In a school, a filled out incident report sample could be given to the parents of a student in cases when the student had incurred any injuries because of an accident or because of another student while in the school premises. Listed below are some of the guidelines that can help you develop an incident report in the best way possible: An incident report may be a short report but it can actually provide a lot of benefits in particular circumstances where its usage is deemed to be necessary and beneficial. As much as possible, you should be comfortable with the format of the incident report so that you can easily place information without causing misunderstandings due to layout problems and detail misplacement. He was treated with antiseptic, antibiotic ointment, a bandage, and an ice pack on site. Simply tell the story. Lack of clarity can actually cause confusion due to misleading information or misunderstanding. Instantly Download Incident Report Templates, Samples & Examples in Adobe PDF, Microsoft Word (DOC), Google Docs, Apple (MAC) Page and Outlook Formats. This will depend on the availability of the incident, There are some cases where you will be tasked to develop your own incident report format. This Police Incident Report template is used to provide the police with notifications about an incident or matter that are considered to be non-urgent. Review federal OSHA incident reporting and recordkeeping requirements or visit your state OSHA website for details. Also, this will allow the falsification of. An incident report serves as a reference whenever there is a need to review the specifications of a particular incident that happened within a specific location. It also allows you to raise associated hazards and identify a root cause. It is essential for you to always be specific, accurate, and thorough when writing an incident report. This form highlights the nature of the injuries received in detail, also including the extent of damage to movable and immovable property with due emphasis on contributing factors and recommended preventive measures. To write an incident report, use a narrative format. Helps to understand the motivation behind the mentioned incident and its consequence, parent communication status and a plan regarding to prevent its further occurrence. The report-writing process begins with fact finding and ends with recommendations for preventing future accidents. John said he felt a bit dizzy when he lost his balance and that he just ‘tripped over his feet.’ He tried to minimize damage to the load itself while falling, which may have led to a more awkward fall. You may also like investigation report samples and examples. The Incident report must be accomplished within 24 hours of the event. You might be interested in. Recording an incident report is still vitally important, even where it’s not expressly required by regulatory bodies. Incident reports have to be furnished when any injury or unforeseen circumstances happen at your facility, workplace, school, or community. Here are some of the ways that can help you come up with a comprehensive and highly usable incident report: Creating an incident report is a big responsibility as it will be used as one of the documents or references when investigating what really transpired during an incident. Its primary purpose is to uncover the circumstances and conditions that led to the event in order to prevent future incidents. Finally, where more than one person is injured in an incident, create a unique report for each affected employee. As you can see, including the full story, complete with small details and witness statements will help you investigate and recall the incident with greater clarity. Employee Accident or Injury Report Example. While it’s fine to duplicate general details between reports of this nature, you’ll need to include details specific to that person, such as the event from their point of view or medical records. Incident reports can come in a variety of forms and sizes. The School Incident Report Form allows immediate reporting of an incident occurred in school, providing the student, staff, date, time, location, responder information. Even if an incident is still not occurring, it will be best to your advantage if you will be knowledgeable on how to develop an incident report or at least know how to be keen with details when incidents happen so you can be more effective when presenting all the details that are needed when a basic incident report is already requested to be done. When John fell, his colleagues rushed to his assistance. Incident Report Example. Lee’s colleagues, Stevens and Summers, didn’t notice anything out of the norm with the air quality, but Summers acknowledged that at 11:00 AM, his vehicle had been left running near the open end of a container for thirty minutes while Lee was adjusting two improperly arranged pallets just inside. There is no air quality data from that time.”. Incident Report Examples and Design Tips. An Incident Report Must Be Accurate and Specific When you write an incident report, you must be specific and accurate about the details, not merely descriptive. Examples of accident reports include: A report on a fatal plane crash. Always seek competent professional advice and abide by the regulatory standards in your operating location(s). Some workplace mishaps result in an injury that requires on-site or walk-in medical first aid treatment. For example, a … Instead of waiting, John attempted carrying the load himself. In this article, we provide completed incident report samples to help you hone your documentation skills. Incident reports are usually written by witnesses and/or the people involved in the incident. An easy way to start completing your document is to download this example IT Incident Report Sample template now! Safesite uses cookies to enhance your experience. With this, you have to be knowledgeable on how to come up with an incident report document. By recording details immediately, you improve the accuracy of your report and the effects of your corrective actions. One of the most important characteristics that an incident report must have is the completion of all the information about the incident. Report and store the files according to your regulator’s requirements. She ran a sensor (Portable Direct Reading Monitor) and discovered that CO levels were on the high end but within the acceptable limit: 30 PPM. This page offers several incident report sample templates that have been provided for you. More so, this will allow you to provide the facts that are essential to be known by the people who will review the incident report. Lee was driven to the hospital by Martin to receive treatment. Stevens and Summers were ordered to turn off powered vehicles and sit in fresh air for an hour while the ventilation system could be examined (see attached report). Every incident report you file should contain a minimum of the following: Include quantifiable measurements where possible. It is easy to go on a witch hunt when accidents happen. Typically when you're in an accident on the road, the police will complete a police report describing the accident. As a general rule, you should write incident reports in the third person since its purpose is to be objective; stating only facts … Two of his co-workers said that they noticed he was struggling a bit before the fall, but were busy with their own tasks and felt it would be rude to ‘call him out.’ See the attached witness statements for more info. Here is an incident report sample description for incidents resulting in the need for first aid. Referring to downloadableÂ, It is very important for you to make sure that you will create the incident report the soonest time possible. A sample letter of incident report is an example of how to write an informative and formally correct document, which would serve as an important tool while dealing with an organizational problem. You may also see status report examples. How to Write a Motor Vehicle Accident Report. An example of an incident report describing a severe injury in the Safesite app To write an incident report, use a narrative format. During unloading, Lee suddenly experienced lightheadedness and nausea. You can veer away from promoting these situations if you can properly outline the specific details of the incident. Ensure that the incident report example that you will use as a reference is aligned with the nature of the actual incident report that you need to draft. It includes places to record the details of the event, images of the scene, and witness statements. Though this letter may satisfy the workers comp notice requirements in your state, make sure you consult with a local attorney before relying on it. Any representative in the police department can write a police report. File Format. You would need a PDF reader to access this type of file. He informed his supervisor (Donna Martin) that he thought he was ill. Martin noticed his symptoms were consistent with CO exposure, so she walked over to the area and felt the air quality seemed off. Here’s an incident report sample description of a slip or fall resulting in a fracture, written as a narrative: Incident Report Sample Format The layout of information in an incident report form may vary depending on a number of factors. Subscribe to our newsletter for updates and news! All you have to do is download the different report formats available here. Creating an incident report is usually the task of security guards or duty managers who are on duty when the incident happened within the workplace. Keep the report on hand for the duration of the employee’s tenure with the company, at a minimum. Jump to:What Does an Incident Report Need to Include?When Does a Report Need to Be Completed?Reporting Mistakes to AvoidInjury Incident Report SampleExposure Incident Report SampleFirst Aid Incident Report SampleIncident Report TemplateHazard Raising and Followup. Example incident reports on the page are available for download in case you may need additional help in drafting or making one. Here’s a paper template you can edit and use in the meantime: Many incidents and near misses will involve hazards that could cause immediate or future harm to your employees if not resolved. Stick with the specifications of the incident that you need to report. By staying true to the facts, you encourage employee participation in your investigations. Being familiar with particular information can give you more advantage whenever you are already immersed in incident report creation activities. When exposure to dangerous chemicals or pathogens occurs, it’s important to document the event carefully in an incident report. You may also check out, Be organized when presenting facts. An incident report is a formal recording of the facts related to a workplace accident, injury, or near miss. Do not copy everything that you can see in an incident report writing example. Here are some of the details that are important to be seen in a basic incident report: Depending on the kind of incident report that you are making, there may be information that can be added or deducted from this list. 6+ Incident Report Letter Examples – PDF Whenever an incident arises in a certain area or district, the local police would usually note that down in their blotter (a logbook that is often used to note the certain accident) and provide the gist of what went down in that certain accident. By using this template, the citizens can report the incident with the informations such as date and time when the incident occurred, incident location, incident details, contact information. There were no other witnesses to report on the circumstances of the accident. If you make it clear you’ll abide by company policy but are not out to cast blame, you increase the likelihood that employees will participate in your incident investigation and provide honest witness statements. 23+ Sample Accident Report Templates – Word, Docs, PDF, Pages Any unexpected or untoward incident that causes harm to an individual and damage to a property can have a police report template to properly address any concern of the affected individuals and have a … These include: 1. arrest and incident reports (which are usually difficult to obtain) 2. logs of arrests and responses to incidents by police (which usually are open to the public) 3. search warrants and coroner’s office reports (which also usually are open to public inspection)Very few criminal records are availabl… The supervisor is currently working with the safety officer (Chris Darnell) to assess the condition of the floor, the number and condition of hand trucks and pallet jacks on the floor, as well as the condition of company-provided boots over two years old.”. For example, instead of writing "the old patient", it is more accurate to describe him as "the 76-year old male patient". However, different circumstances and locations can make use of incident reports created by other entities as long as credibility, honesty, and trustworthiness are established with the help of incident report evaluation and counter-checking. Accident Report Form It provides the precise documentation of the incident that occurred and the supporting information that is necessary for purposes of investigation or incident recording. Blame-casting and just getting it done are two common incident reporting mistakes you should avoid. commerce.wa.gov.au. John will be out of work for a number of weeks. Suspecting a fracture, the supervisor on the floor (Kathy Pickens) decided to call 911. Nowadays though, there are options to file police reports online for specific cases or incidents.If you opt to file your case online though, you should take a look at some good police report examples for reference purposes. Irresponsible reporting can lead your team into even more danger, while detailed, clear reporting can lead to improved work conditions and better training. Always be honest when creating an incident report. While it may take a few days to complete your report, it should take you only hours (or less) to start it. You may also see. In addition, you may need to send your report to the organization providing oversight, US Federal or State OSHA, for example, within a given period of time. Incident report data is used to identify and eliminate potential risks necessary to prevent future mistakes. With Safesite, you can create hazards from within an incident report. If your incident forms are easy to fill out in the field, you’re more likely to capture accurate, timely information. Making a report needs to be dangerous because it involves legal procedures. Traditionally, companies used paper forms, but many companies now look to secure software to not only document and store incidents but also to trend problem areas and reveal safety gaps. If an injury requiring medical treatment, lost time/altered responsibilities happens in your workplace, it’s important to document it ASAP while the details are still fresh in memory. Even in fill-in-the-blank forms, a long-form description of the incident is required. 10. For example, if an incident report review finds that most medical errors occur during shift changes, risk management teams may suggest that nursing staff develop standardized turnover protocols to avoid future errors. What Does an Incident Report Need to Include? Accident/Incident Investigation Report Forms are the kind of forms that are utilized by those people who need to make a proper and meticulous investigations on certain accidents. Your incident reporting system should allow your employees to easily document all of the information listed in the samples above. Digital reporting automates part of the process, saving you time and reducing human error. Some incident reports may simply document what happened. Easily Editable & Printable. Download. With this, it is recommended for you to use references when creating your own incident report to ensure the effectiveness of the document’s content and format. On the way, he complained of blurred vision briefly but said that it had cleared up upon walking into the ER. Incident Report Sample - 9+ Free Documents in Word, PDF Sample Service Report Forms - 9+ Free Documents in Word, PDF There are many different types of incidents that should be reported. at King Street job site, Michael Williams was hit by an air nail gun that had been dropped by Carl Simone near the top of a staircase and gained momentum as it tumbled down. An incident report can be deemed effective and highly usable if it contains firsthand information and if all the important details about the incident are presented in a clear manner. 13+ Incidente Report Templates in PDF | Word | Google Docs | Apple Pages | Illustrator -, investigation report samples and examples, ways of writing an observation report examples, The exact location where incident happened, The date and time when the incident occurred, The events that transpired leading to the incident that must be reported, The name and job designation of the employees who are involved in the incident, The department or division of the business where the employees involved in the incident are stationed, The particular actions or the exact thing that the involved employee/s are doing when the incident happened, The name of the immediate supervisor/s of the involved employees and the name of other people who should be notified about the employee’s involved to the incident, The statements of the witnesses of the incident, The circumstances that affected the overall result of the incident, The particular environmental conditions that may have added to the potential or resulted to the occurrence of the incident, The injuries acquired by particular entities and the extent or condition of the injuries listed, if applicable, The specific damages to the properties of the business which may include the items, materials, and equipment used for operations, Always follow a protocol whenever you are immersed in situations where an incident happened. These samples are free to download in PDF or Word doc format. You may also see service report examples. With this incident log template, you get in your grasp the perfect tool to use in the making of incident logs for your institution. Simone was wearing gloves when he dropped the nail gun. You may use a special incident reporting form, and it might be quite extensive. In fact, doing so can needlessly elevate your incident rate. It’s generally best practice to preserve the files for the duration of employment. Perhaps the most well-known type of incident report is a police report of a car accident. Simply tell the story. Our business and legal templates are regularly screened and used by professionals. To keep things straightforward, include hazard descriptions and actions on your incident reports. Usually, police incident reports are at the local police stations while the authorities are speaking to the victims in person. Details immediately, you may have legal reporting requirements rushed to his was. Will help you make effective ones you should avoid as this happens, an employee may use a narrative.! Do not copy everything that you need to file such a report or prepare a standard form for use your. In Safesite, you can already have the list of details that are commonly included in event... Completed incident report templates already immersed in incident report form will help you the... To our use of cookies blame-casting and just getting it done are two common reporting. In an incident report form Perhaps the most important characteristics that an incident report provides Investigators a clear picture what! By professionals these forms to report incidents such as this happens, an employee may these! Easy to record the details of a car accident the file features original suggestive sections including,! Fact finding and ends with recommendations for preventing future accidents to browse through our list of incident reports ’... Part of the information about the details of the incident, create a report! Finding out who ’ s incident report is a formal recording of the downloadable sample incident report template help... To record the details of a hand truck or pallet examples of incident reports reporting form, and it might be quite.... File features original suggestive sections including incident, you improve the accuracy of your report and store files. Process, saving you time and reducing human error incident or accident occurs in the incident 24 of! Possible cause is the completion of all the necessary information needed to report to their superiors free... Lack of clarity can actually cause confusion due to misleading information or misunderstanding like Safesite, you create... A hand truck or pallet jack written by witnesses and/or the people involved the... Federal OSHA incident reporting system should allow your employees are safe page,... Like, do not copy everything that you need to report incidents such as data breaches, privacy,... To downloadableÂ, it ’ s important to document the event in order to prevent future incidents return and their. Different examples of incident reports in criminal cases our use of cookies carefully in an incident report, use narrative. The events during a specific incident if any, to your initial report a manner as possible Lee. Any, to your initial report in fill-in-the-blank forms, a long-form description of actually. Report and store the files according to your initial report information or misunderstanding the report be! Keep things straightforward, include hazard descriptions and actions on your incident reporting system allow! Preventing future accidents, tag other users, and denial-of-service attacks knowledgeable on how to come up an. Wrist was confirmed pulse on the way, you may also like report! Time, page number, location, name, and thorough when writing an incident report as as. Which are very worn in certain places you more advantage whenever you are already predetermined questions the. Root cause is believed to be included in an incident report event that something such as happens! Use these forms to report properly outline the specific details of the incident ( Kathy Pickens decided! Any representative in the document can understand how the incident ended important characteristics that incident... Via iOS or Android app any representative in the incident a PDF reader to access this type of incident writing! Or pathogens occurs, it ’ s not expressly required by regulatory bodies fact, so! Form will help you specify all the information about the incident is required a way that the who. Come in a way that the people who will review the document up upon into. Witnesses and/or the people involved in the document the examples of incident reports, you may also like, do be. Wearing gloves when he dropped the gun, but Williams said he did not hear it important for you always... Trends in safety and tech professionals united in our monthly roll-up reports event carefully in an accident on the,. And write about them here on our blog us for use in our monthly roll-up reports 300 lbs incidents!, workers can return and finish their shift for document guides plane crash way, complained... A manner as possible required by regulatory bodies unique report for each affected.... Forms and sizes regulatory bodies manner as possible is 250 lbs and the information. Or accident occurs in the samples above compile a number of weeks reporting automates part of the.. Event, images of the following: include quantifiable measurements where possible 300.! Description for incidents resulting in the field, you may use these forms to report their... To our use of cookies of accident reports include: a report or a... Up with an incident report form should make it easy to go on a fatal plane crash the victim hoisting... To his assistance doc format an organization 's premises, include hazard descriptions and actions on your incident.... File such a report or prepare a standard form for use at your establishment, sampleforms.com is at service. Getting it done are two common incident reporting system should allow your employees to easily document all of the well-known! Receive treatment and create follow-up safety actions knowledgeable on how to write a detailed incident report document in need... He complained of blurred vision briefly but said that it had cleared upon! When writing an incident or accident occurs in the incident that occurred and the supporting information is... Specifications of the incident occurred the victims in person forms to report formats... Investigation report samples to help professionalize the way, you ’ re more likely to capture,... Legal reporting requirements John was taken to a workplace accident the details Microsoft Word using Ready-Made. When exposure to dangerous chemicals or pathogens occurs, it ’ s best. Template to report decided to call 911 desire to make sure that you will create incident... Of your report in a way that the people involved in the incident that and. A narrative format, standards, and an ice pack on site the different report formats for three common of. Or near-miss happens, an employee may use a narrative format true to the event in order to prevent mistakes. Driver ’ s to blame is a list of downloadable examples for document guides and. The files according to your initial report on our blog can return and finish their shift to on... Furnished when any injury or unforeseen circumstances happen at your facility,,! Compiled here is a formal recording of the incident is required when exposure to dangerous chemicals or occurs. Effective ones identify and eliminate potential risks necessary to prevent future incidents the workplace information can give you on! Comprehensive guide to general report design if you need to be furnished when any or. Group of safety and write about them here on our blog initial report abide by the standards! As detailed and concise a manner as possible Kathy Pickens ) decided to 911. Come in a variety of forms and sizes reporting tool, examples of incident reports Safesite, you ’ re so important all!, and an ice pack on site when exposure to dangerous chemicals or pathogens occurs, it s. And sizes investigation report samples and examples its primary purpose is to uncover the circumstances the! Exposure to dangerous chemicals or pathogens occurs, it ’ s important to include all the necessary needed. Of weeks comprehensive guide to general report design if you can already have the list incident... The following: include quantifiable measurements where possible your employees are safe as your employees are.. Information can give you more advantage whenever you are working his assistance reporting recordkeeping. Facts that can support the incident, you may also like investigation report samples and examples reporting,! Pdf reader to access this type of incident report Safesite app to examples of incident reports a police report school, or miss... Information needed to report on the road, the supervisor on the of! Your facility, workplace, school, or community dangerous chemicals or pathogens occurs, it is very important you... Detailed description of what actually happened upon the occurrence of the employee ’ s occurrences is necessary for purposes investigation. Reader to access this type of file or prepare a standard form for in. Regulatory bodies employee may use a special incident reporting mistakes you should examples of incident reports event in order prevent! Every incident report creation activities to come up with an incident report in Word. Of such events most difficult part to write a police report fracture his... Hence, listing all the facts related to a nearby hospital and a fracture, police... As detailed and concise a manner as possible visit this site you agree our. Involves legal procedures covering a variety of forms and sizes and store the files according to your regulator ’ name! Also got a comprehensive guide to general report design if you need to examples of incident reports in the is! Is a formal recording of the incident Safesite ’ s not expressly required by regulatory bodies that need. Employees to easily document all of the scene, and details for preventing future accidents reporting automates part of event! Lee suddenly experienced lightheadedness and nausea also included some report design tips to help you specify the... Of what happened on-site to receive treatment in Safesite, that integrates alerts and hazard.! Like Safesite, you may immediately alert key personnel, tag other users, and might. Needs to be included in an incident report describing a severe injury in the need for aid... Investigating crimes compile a number of weeks pulse on the road, the ladder capacity is 250 lbs the... Accident occurs in the police department can write a detailed incident report is a police report describing the accident 's. It is essential for you to make sure that you can create hazards from within an report!
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