HomeMy WebLinkAboutFD-31 - Possible Substance Use Incident Report
Member Involved
Date of Incident
Time of Incident
Member’s Job Position/Assignment
Has employee been notified of his/her right to union representation?
Yes No
Time
Member’s Initials
Witnesses to Incident
What was Observed
What is Member’s Explanation
Action Recommended
Action Taken
1. Signature
Title
2. Signature
Title
Date, Time, Action Taken
, ,