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Accident Re_vort <br /> <br />Name of ~jured: <br /> <br />Address of Injured: <br /> <br />Date and Hour of Injury: <br /> <br />Place of Accident: <br /> <br />Age of Injured: <br /> <br />Nature of Injury: <br /> <br />How Accident Occurred: <br /> <br />What Action was Taken: <br /> <br />WITNESSES: Name <br /> <br />Address <br /> <br />Telephone <br /> <br />Name <br /> <br />Address <br /> <br />Telephone <br /> <br />THIS REPORT MADE BY: <br /> <br />DELIVER THIS REPORT TO THE PARKS/UTILITIES SUPERVISOR <br /> <br /> <br />