Member-Client or Visitor Incident Report

Type of Report

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Who is submitting this report?

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Person  involved in the accident, near miss or Incident.

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Did an injury occur?
Medical treatment required?
If yes, what type?

Describe Event or Incident

Incident Report Submitted

Contact:

Chris Tibbs_rev.jpg

Chris Tibbs

President & CEO

(360) 801-0116

CTibbs@penarc.org

Kim Bushnell.jpg

Kim Bushnell

Chief Operating Officer

(360) 801-0628

KBushnell@penarc.org

George Skurtu.jpg

George Skurtu

Director

(360) 801-2841

GSkurtu@penarc.org