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Employee Incident Report
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Violating employee's name
*
First
Last
Reporting employee's name
*
First
Last
Reporting employee's email
*
Date / Time of incident
Date
Time
Address of incident: (HOM or other)
*
What violation has the employee committed?
Neglect of Duty
Failure to Follow Instructions
Inappropriate Behavior
Attendance Related
Damage to Company Property
Theft
Harassment
Poor Work Performance
Violation of Company Policy
Please describe the incident
*
List any possible witnesses
Proposed resolution or follow up recommendations
*
Report prepared by
*
First
Last
Submit
