Get Canada Lakeland Security Services - Incident Report Form 2012
Supervisor: Will the employee miss time from work because of this incident? Yes/No ________________________________ II. INCIDENT INFORMATION Date: Time: Location: Police Notified? Yes/No Case # Describe Incident: (Be as specific as possible.) Continue on back of this form, if necessary. Was there an injury? Yes/No If Yes, Describe Injury: Continue on back of this form, if necessary. Medical Treatment Provided: None First Aid Refused Medical Treatment ER Walk-In Cl.
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