Safer 10-inch Table Saws – Report a save

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Date of Occurrence:*
Approximate Time of Day:*
Company Name:*
Company Phone:*
State/Province:*
Email:*
Name of person who touched blade:*
Number of years operator has used saws or been a woodworker:*
Table Saw Serial Number:*
Brake Cartridge Serial Number:*
RMA Number:*
Type of Saw:*	Industrial Cabinet Saw Professional Cabinet Saw Contractor Saw
Name of the Person Filling Out This Form:*
Body Part Contact (right or left hand, finger, thumb etc.):*
Was there a visible mark or injury?:*	Yes No
How was the injury treated?:*
Type of Material Being Cut:*
Material Dimensions and Type of Cut Performed:*
Was a Blade Guard, Riving Knife or Splitter in Place (please specify):*
Type of blade being used:*	10" Standard 8" Dado Other
If Other, please describe:
If a Standard 10" Blade was being used, how many teeth on the blade?:
Were there other devices being used when the cut was made?:*	Push Stick Feather Board Miter Gauge Other
If Other, please describe:
As far as you know, did the incident involve a kickback situation?:*	Yes No
Was the saw operator wearing gloves at the time?:*	Yes No
What was the approximate feed rate of the material when the accident occured? (inches per second):*
To the best of your ability, please describe the circumstances of how the accident happened:*
Estimate of the injury if it were to have occurred while using a non-SawStop saw:*
Would You Be Willing To Give SawStop A Testimonial About Your "Finger Save"? (Please use this space for your testimonial):
Would You Be Willing To Allow SawStop To Use Your Testimonial or Your "Finger Save" Story For External Marketing And Promotional Purposes? (web sites, magazine advertising, direct mail and various other printed materials etc.):*
	Yes No