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Get Broward Schools Incident Report Template

S. Complete this report in full and submit the original to HR immediately after the incident. Do NOT make copies of this report. Fax the completed report to 800-873-5292. Last Name, First Middle Initial Associate PERSON INJURED Date of Birth Male Visitor Female Member Street Address Member ID # City, State, Zip Code Contact Number Date of Incident: Time of Incident: Location (Be specific and include facility name, street address, building number, floor, direction such as NE corner, e.

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