Supervisor Incident Evaluation Report | Barona Resort & Casino

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Your Name:(Required)

Badge Number:(Required)

Incident date:(Required)

Date staff member made report:

Staff Badge Number:(Required)

Position Title:(Required)

Location of Incident:(Required)

What body part was injured?(Required)

What happened?(Required)

What caused this incident?(Required)

Please explain, if yes:(Required)

What device was the staff member using?(Required)

By whom?(Required)

Date last inspected:

Date of training:

What was employee’s explanation of why this incident occurred:(Required)

Today's Date:(Required)

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