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Accident/Incident Report
Employees should report incidents involving personal injury or property damage. Managers/Supervisors should complete the form and send to the Farm Office.
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Date/Time of Incident
MM
/
DD
/
YYYY
Person Involved
Your answer
Personal Injury
Yes
No
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Location
Your answer
Incident Details
Your answer
Others Involved/witnesses - List names and contact info
Your answer
List info of any involved vehicles or equipment
Your answer
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