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Cornerstone Incident Report #2
It is best to complete this form as soon as possible after the incident, preferably within 24 hours.
This form may or may not need to be completed
.
Name of person/witness filing report
Phone
Email
Date of Incident
Time of Incident
12:00 AM
12:05 AM
12:10 AM
12:15 AM
12:20 AM
12:25 AM
12:30 AM
12:35 AM
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Choose a time
If Law Enforcement was utilized, include officer name and badge number
If a police report was filed, include case number here
Any further injury details such as care provided by bystanders and hospital destination
Any additional information you would like to include
Submit
Thanks for submitting!
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