Employee Incident Report Form

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Employee Incident Report
Company Name: _____________________________________
Date
Employee
Manager
Name
Name
Title/position
Title/position
Incident
Date
Time
Location
Description of incident
Employee explanation
Witnesses
Action to be taken
 None Required
 Probation
 Dismissal
 Written warning
 Suspension
 Other
Explain
By signing this document, you acknowledge that you have read and understood
the information contained herein
Employee
Manager
Date
Date

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