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i <br /> I <br /> INCIDENT NOTIFICATION <br /> This form must be completed when an employee has been involved in an accident during work hours; <br /> that might require medical treatment. <br /> DATE OF INCIDENT <br /> EMPLOYEE'S NAME <br /> (print) <br /> EXPLANATION OF INCIDENT: <br /> I <br /> I do feel that medical treatment is necessary at this time. <br /> Initial <br /> I do not feel that medical treatment is necessary at this time. <br /> Initial <br /> Employee's Signature Date <br /> Supervisor's Signature Date <br />