Incident Report Form Sample Clauses

The Incident Report Form clause establishes the requirement for parties to document and report any accidents, injuries, or unusual events that occur in connection with the agreement. Typically, this clause outlines the process for completing a standardized form, specifies the timeframe for submission, and may detail the information that must be included, such as the nature of the incident, those involved, and any immediate actions taken. Its core practical function is to ensure timely and consistent communication of incidents, which helps manage risk, supports compliance with legal or insurance obligations, and facilitates appropriate follow-up actions.
Incident Report Form. Cashmere School District Incident Report Form Therapeutic Hold? Y / N
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Incident Report Form. The person reporting the alleged activity will also document the date, time, and circumstances involved by filling out an “Incident Report From” (see Attachment H) as soon as possible after making a report.
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Incident Report Form. Any incident viewed and controlled by a Monitoring Officer must be detailed on an Incident Log maintained at Brunswick Police Station and retained on file. Issue No. Issue Date Description of Amendment Authorised by 1 Original
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Incident Report Form. Name of Employer Employee Involved Date of Incident Time of Incident Location of Incident Employee’s Job Classification Has employee been notified of his/her right to Union representation? Date Notified Time Notified Employee’s Initials Witness(es) to Incident EMPLOYEE’S EXPLANATION Action Recommended Action Taken Date & Time of Action Taken Signature: Employer Representative Signature: Union Representative (if present) Title Title I, , understand that my Employer has adopted a Substance Abuse Policy which allows for-urine drug and/or alcohol testing for reasonable cause. I have been requested to provide a urine specimen which will be tested for the presence of Cocaine, Opiates, Phencyclidine, Marijuana, the Amphetamine Group and Ethyl Alcohol. I may refuse to provide a urine sample, but disciplinary action by my Employer, up to and including discharge, may result if a sample is not provided. All charges for this urine test for drugs and/or alcohol will be paid for my Employer, and not by me. Date: Time: Employee Name: (Printed Name) I, , understand that (Name) (Employer) has adopted a Drug and Alcohol Policy which provides for pre-employment drug and/or alcohol testing of dispatched workers and applicants for employment. I understand that any offer of employment is subject to and conditioned on: (1) my consent to take a drug and/or alcohol test; and (2) a negative test result. I have been requested to take an oral fluid test which will be tested for the presence of Cocaine, Opiates, Phencyclidine, Marijuana, the Amphetamine Group and Ethyl Alcohol.. I understand that if this oral fluid test is positive or inconclusive, I will be requested to provide a urine specimen which will also be tested for the above-referenced substances . All charges for this testing for drugs and/or alcohol will be paid for by the Employer, and not by me. Date: Time: Dispatched Worker IT IS AGREED between the undersigned Employer and Northern California district council of plasterers and Cement Masons (Union), in consideration of services performed and to be performed for the Employer by employees represented by the Union, as follows:
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Incident Report Form. Introduction 1. All campers must have a memorable experience both on and off the training ground. 2. All Campers must have “FUN” 3. All campers must learn new skills that will enhance their standard of play. 4. All campers are encouraged to make new friends and enjoy each other’s company 5. All campers must experience competitive play 6. All campers must leave camp feeling that they want to return. The Director’s Guidelines has been developed as a guide to convey Sports Camps Australia’s expectations on how to execute a successful camp. Please feel free to call us if you have any suggestions on ways to improve our camp model for all parties. We are passionate about this business and we value our partners and Camp Directors so we endeavor to continually improve our camp business. Good luck and enjoy the camp.
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Related to Incident Report Form

  • Incident Reports Any serious occurrence involving a beneficiary, outside the normal routine of the OTP (see TRICARE Operations Manual (▇▇▇), Chapter 7, Section 4), shall be reported to the referring military providers and/or Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) referral management office (on behalf of the military provider), and DHA, and/or a designee, as follows: (a) An incident of a life-threatening accident, patient death, patient disappearance, suicide attempt, incident of cruel or abusive treatment, or any equally dangerous situation involving a beneficiary, shall be reported by telephone on the next business day with a full written report within seven days. (b) The incident and the following report shall be documented in the patient’s clinical record. (c) Notification shall be provided, if appropriate, to the parents, legal guardian, or legal authorities.

  • Incident Reporting Transfer Agent will use commercially reasonable efforts to promptly furnish to Fund information that Transfer Agent has regarding the general circumstances and extent of such unauthorized access to the Fund Data.

  • GRIEVANCE REPORT FORM Grievance # School District Distribution of Form 1. Superintendent

  • Accident Reports If any of the Equipment is damaged, lost stolen, or destroyed, or if any person is injured or dies, or if any property is damaged as a result of its use, maintenance, or possession, You will promptly notify Us of the occurrence, and will file all necessary accident reports, including those required by law and those required applicable insurers. You, Your employees, and agents will cooperate fully with Us and all insurers providing insurance under this Agreement in the investigation and defense of any claims. You will promptly deliver to Us any documents served or delivered to You, Your employees, or Your agents in connection with any claim or proceeding at law or in equity begun or threatened against You, Us, or both You and Us.

  • Incident Notification Google will notify Customer promptly and without undue delay after becoming aware of a Data Incident, and promptly take reasonable steps to minimize harm and secure Customer Data.