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U.S. Department of Labor Occupational Safety and Health Administration 1648 TRI Park Way Appleton, WI 5491411/02/2021 Alpaca Foundry, Inc. and its successors 805 Ogden Street Marionette, WI 54143

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This form is a mandatory reporting requirement for occupational safety and health incidents in Wisconsin.

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Employers in Wisconsin are required to file this report for occupational safety and health incidents.

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The form can be filled out online through the Wisconsin Occupational Safety and Health Administration website.

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The purpose of the form is to track and analyze occupational safety and health incidents in Wisconsin.

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Information such as incident details, injuries sustained, and corrective actions taken must be reported on the form.

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