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To submit a paper copy by fax, please click on this link.

1. Contact Information

First Name
Last Name
Phone

2. Incident Location

Date
Calendar
Location
Location Address
Approximate time of incident
Production Title

Locations Manager:

FirstLastPhone

Film Coordinator:

Permit Office
FirstLastPhone

3. Incident Description

Brief Description of Incident:

Action Taken:

Follow Up:

4. Incident Witnesses

Witnesses / Police:

Witness 1

FirstLastPhone

Witness 2

FirstLastPhone

Witness 3

FirstLastPhone

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