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  • 2025 Incident Reporting

    The purpose of this Incident Report Form is to document all incidents that occur while serving or working with ACE. This form should be completed any time there is an incident of concern that you want ACE to be aware of, a near miss, an incident that may require future treatment or a possible worker's comp claim, or any incident that may need follow up at any given time. Please complete this form thoroughly and include as many details as possible.
  • Instead of using the Incident Response form, use the ACE Complaint Form, which allows you to maintain greater privacy with who you email the form to (copy/paste into a new web browser):

    https://drive.google.com/file/d/1zfUlvP-kCq_zspjssMMpB5JB04St23iz/view
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  • Initial Incident Description Section

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  • Illness

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  • Injury, Extreme Weather & Evacuation Section

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  • Near Miss Incident Section

  • Social/HR/Behavioral Section

  • Bites and Stings Section

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  • Vehicle Incidents Section

  • Additional Information to Collect for a Potential Worker's Comp Claim

    The following are in reference to the injured individual unless otherwise noted
  • This section is only needed to help staff file a potential worker's compensation claim. If you are fairly certain this incident may lead to a worker's compensation claim (prolonged missed work/service due to an injury), please fill out as much of this information as you can (you can skip areas as needed). If you don't think this incident will lead to a worker's compensation claim, you can skip this entire section. If you have concern that circumstances may change, know that this information can be gathered at another time.
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  • Additional Information, File Uploads and Signature Section

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