• Incident or Near Miss Report

    Incident or Near Miss Report

    Call a manager as soon as possible. Refer to accident procedure in glove box or jotforms for more information.
  • IF YOU OR SOMEONE ELSE IS SERIOUSLY INJURED CALL 911 IMMEDIATELY

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  • Employee’s shift on the day of the incident/near miss

  • Injury Information

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  • Any person who knowingly and with intent to injure, defraud or deceive any employer, employee, insurance company or self insured program, files a statement of claim containing any false or misleading information is guilty of a third degree felony.

  • Additional Information

  • Additional Information

  • If you are able, take as many photos as possible including the location, damages, injuries and other parties involved.

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