City of Concord Risk Management

riskmanagement@concordnc.gov

35 Cabarrus Ave W.
Concord, NC 28025

704-920-5109

Print Document

When you click Print below we will prepare a printable document for you. It will automatically download when it's ready.

Did you know?
You can fill in the document online and then click the print icon and all of your information will be populated in the printable document, saving you time later.

SeamlessDocs

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

Please acknowlege below to continue

Please check that you agree before continuing.

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

Signature HereClick to Sign

07/02/2025Click to Sign

Signature HereSupervisor Signature Will Sign Here

07/02/2025

Signature HereDepartment Director Signature Will Sign Here

Signature HereRisk Management Will Sign Here

07/02/2025

Signature HereSecond Supervisor Signature Will Sign Here

07/02/2025

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

Full Legal Name

Your Initials

Signature Type

Type Draw Upload Custom

Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Additional Signatures Required

Document Signers

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

Upload Attachment(s)

Please upload the following attachments:

There is a 250MB limit on each attachment.

Photos 1 Click Here to Upload

Photos 2 Click Here to Upload

Photos 3 Click Here to Upload

Photos 4 Click Here to Upload

Photos 5 Click Here to Upload

Skip

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

	Signer Details	Me?
Employee Signature
I'm not a signer listed above

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

Create Your Signature

Upload Attachment(s)

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

Other Signers (The signers below will be invited to sign once the above signers have signed.)

Risk Management