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UCSF/SFGH ED Staff Event Report Form
This data is strictly for departmental database only. Information provided in this form is confidential and will not be discussed outside of the conflict resolution committee without the reporters permission.
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* Indicates required question
Name and Role (both optional):
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Email (optional):
Your answer
Date & Time of Event:
*
Your answer
Personnel involved (First & Last name):
*
Your answer
Description of Event (as detailed as possible):
*
Your answer
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