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HANCOCK COUNTY INJURY REPORT (NON-EM PLOYEE)
(Forward Completed Form to hancock-hr@hancockin.gov)
DATE: ___
NAME: ___
ADDRESS: ___
FORM COMPLETED BY: ___
LOCATION OF INJURY/ ACCIDENT:
DESCRIPTION OF ACCIDENT/ INJURY:
TYPE OF INJURY:
WITNESS(ES) TO ACCIDENT:
COMMENTS: