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GE INJURY NON-INJURY ILLNESS NEAR-MISS OTHER Name of employee injured, ill or exposed (if applicable): Classification: EMPLOYEE WORK EXPERIENCE: Full Time Part-Time Seasonal Other: How long in current assignment? How long with the Department? What is the apparent nature of the employee’s injury/illness? THE ACCIDENT SCENE: Describe the accident scene. Where did the accident happen? (Example: In the 2nd floor stairwell at 4:20 pm of the Miami Riverside Center Bldg.) 30 City of Mi.

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