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CONFIDENTIAL CEC Incident Report This is Only for Our 2019-2023
Chest Face NAME OF PERSON WHO ADMINISTERED FIRST AID WHO WAS NOTIFIED Abdomen Hand Foot RELATIONSHIP TO INJURED FORM GIVEN Home Doctor Hospital Classroom IF INJURED PUPIL LEFT SITE TO WHOM RELEASED NAME AND ATTITUDE OF ANYONE CONTACTING SCHOOL/ DISTRICT IS STUDENT INCIDENT BENEFITS AVAILABLE NAME OF COMPANY REMARKS For your protection California law requires the following to appear on this form. It is unlawful to a present or cause to be presented any false or fraudulent claim for payment of a...
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