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WITNESS INCIDENT STATEMENT
To be completed by all witnesses and sent to the Safety Department.
Must be submitted within 24 hours
Incident Information
Describe what happened. Be specific and detailed.
The facts as I have stated them are true to the best of my knowledge.
Employee
Signature
Date
MM slash DD slash YYYY
Additional Email 1
Send a notification to an additional email
Additional Email 2
Send a notification to an additional email
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