Employee Incident Report Part 2 Employee report code * Required Enter the code you received in email. It will start with the employee's last name and have a 5 digit number after it.District * RequiredAberdeenAdnaArlingtonBoistfortCentraliaChehalisCosmopolisElmaESD 113ESD 113 - Early LearningEvalineGrapeviewGriffinHood CanalHoquiamLake QuinaultMary M KnightMcClearyMontesanoMortonMossyrockNapavineNorth BeachNorth RiverNorth ThurstonOakvilleOcostaOlympiaOnalaskaPe EllPioneerRainierRaymondRochesterSatsopSheltonSouth BendSouthsideTaholahTeninoToledoTumwaterWhite PassWillapa ValleyWinlockWishkah ValleyYelmDate incident investigated * Required MM slash DD slash YYYY Injured employee's name * Required First Last Employee email * Required Employee's reported date of incident * Required MM slash DD slash YYYY Describe reported incident, per your findings * RequiredDescribe what was found to be unsafeEmployee actions, equipment, lighting, clutter, etc.Equipment damagedYesNoN/AIf yes, describe equipment damage Follow up action * RequiredProvide a brief description of follow up actionFollow up by Provide nameHas employee missed work due to incident?Yes, employee has missed workNo, employee has not missed workLast date employee worked MM slash DD slash YYYY Date employee returned to work MM slash DD slash YYYY If the employee has not returned to work, leave this response blank.Is light duty work available?YesNoUnsureN/AYour name * Required First Last Your phone number * RequiredYour email * Required Your job title * Required