Form used in Ashtabula County, although it is 2 pages. Thanks! Lori Larson, Risk Manager Ashtabula County Commissioners 25 West Jefferson Street, 3rd Floor Jefferson, Ohio 44047 Phone: 440.576.3649 Fax: 440.576.3502 From: CORSA-broadcast [mailto:corsa-broadcast-bounces@corsa.org] On Behalf Of Hardin EMA Sent: Thursday, August 30, 2018 3:57 PM To: 'CORSA Broadcast Email' <corsa-broadcast@corsa.org> Subject: [CORSA-broadcast] Incident report Hardin County is looking to update their Unusual Incident Report, a one-page form that any county employee can complete when they observe or notice an accident, injury, or any unusual event or circumstance that may involve a member of the public, county property, or county employee. This is separate from a BWC Employee Report of Injury or Illness, but would include some of the same information in some circumstances. Would any county be willing to share anything they use that might help us improve our form? Thank you, Max Trachsel Hardin Co. EMA & Loss Control 419-674-2276