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Incident Investigation Form

Steps

  1. 1. Supervisor's Report
  2. 2. Safety & Risk
  • Supervisor's Report

    1. Level of training received for specific task:*

    2. Any Damage to City or Private Property?*

    3. Is employee currently out of work?*

    4. Does the unsafe condition which caused the injury still exist?

    5. Do you question the validity of the injury?*

    6. Did the injury occur during employee's scope of work?*