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Get Lawrence University Employee Injury & Incident Report

A email to safety@Lawrence.edu and/or hard copy delivered within 24-hours. Employee Name _____________________________ Department__________________________________ Occupation (job title) _________________________ Supervisor____________________________________ Hire Date___________________________________ Change in job duties/location in last 3 months: Date of Injury _______________________________ Time of Injury_______________ (Hour-Minutes) Date of Birth ________________________________ Home/Ce.

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