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E(s) of the California Department of Corrections: Employee(s) Name Date(s) of Incident Description (Job title, ID number, vehicle and license number, home address, etc.) Time of Incident Employee’s Work Location (if known) Location of Incident Details of Complaint (Include nature of complaint, names and addresses of witnesses and other involved parties, names of any law enforcement or social services agencies, doctors or attorneys contacted, a chronology of the events, etc. It is importa.

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