City of Concord Risk Management

riskmanagement@concordnc.gov

35 Cabarrus Ave W.
Concord, NC 28025

704-920-5109

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This form must be signed and submitted within

24 hours

of reported incident. (Please be sure to click "

Finalize and Submit

" after signing.)

You will be prompted to attach photos after submitting the form

riskmanagement@concordnc.gov

All signatures on this report verifies that the statements made are true and accurate to the best of the signers knowledge

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08/31/2025Click to Sign

Signature HereSupervisor Signature Will Sign Here

08/31/2025

Signature HereDepartment Director Signature Will Sign Here

Signature HereRisk Management Will Sign Here

08/31/2025

Signature HereSecond Supervisor Signature Will Sign Here

08/31/2025

Additional Signatures Required

Document Signers

- 1 Employee Signature
- 2 Supervisor Signature
- 3 Second Supervisor Signature
- 4 Department Director Signature
- 5 Risk Management

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City of Concord Risk Management

Print Document

This form must be signed and submitted within

24 hours

of reported incident. (Please be sure to click "

Finalize and Submit

" after signing.)

You will be prompted to attach photos after submitting the form

Other supporting documents (Additional photos, Police Report e.t.c.) can be emailed to

riskmanagement@concordnc.gov

All signatures on this report verifies that the statements made are true and accurate to the best of the signers knowledge

Please acknowlege below to continue

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Risk Management