Rebuilt HTML — PaddleOCR-VL (Baidu)

Content placed at each item's bbox to mirror the original PDF layout (font sizes are estimated). overlay · view JSON

Semantic Positioned (like PDF)

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: