INJURY REPORT
Accidents must be reported to the system within 24 hours. If 911 is called, refer to the 911-Emergency Response Plan. This form must be submitted into the system within 24 hours of Injury/Accident.
Activity/Event *
Your answer
Injury Date *
MM
/
DD
/
YYYY
Location *
Your answer
Injury Time *
Time
:
Injured Person *
Name, Address, Cell #
Your answer
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