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  • If the prevention or mitigation suggestion has been implemented please report the number of weeks that occurred between the identification of the mitigation and the implementation of the mitigation.

  • If the failure or malfunction of a device or piece of  equipment is integral to or caused the event, please fill in the following information:

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Center for Leadership, Innovation and Research in EMS • 23 W Central Entrance, PMB 321 • Duluth, MN 55811
320-229-3621 • 320.251.8154 (fax) • Contact Us