Administration & Support Incident Report Form

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Struck By
Struck Against
Contact With
Caught On
Caught in or between
Fall Same Level
Fall Different Level
Exposure
Over exertion
Incident_Type_Other
NO_Injury
Laceration
Contusion
Puncture
Strain or sprain
Abrasion
Burn
Dermatitis
Crushed
Injury_Type_Other
First Aid
Property Damage
Injury
Illness
Motor Vehicle Damage
PPE Required
PPE_Used?
Do_you_require_medical_treatment?
Police_report
Windshield Damage
Employee_or_Citizen
Witness?
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