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No Accident Certification Record <br />Location: Week Ending: <br />By my signature below, I certify that during the period specified above I have not been injured <br />during my work shift(s), nor have I witnessed an accident resulting in injury to someone else. <br />Por mi firma abajo, yo certifico que durante el periodo especifico encima de yo no ha sido <br />herido durante mi cambio (s) del trabajo, ni tiene presencie un accidente teniendo coma <br />resultado la herida a otra persona. <br />PRINT OR TYPE <br />42 <br />SIGNATURE <br />