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Safety Incident Report
Date of Incident
Incident Time
Injured Name
Incident Type
Injury
Near Miss
Equipment Damage
Fire
Security
Down Time
Spill/Release
First-aid treatment
Death or serious incident
Incident Location
Job Number
Police File
Reporting Officer
Precinct
My District
Supervisor Name
Body Part Injured
Activity during Incident
Incident Description
Reported By
Report Date
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