Policy Text
INCIDENT REPORT
KERN COUNTY SHERIFF'S OFFICE WORK RELEASE PROGRAM
Worker's Name: WRP#
Worksite# Agency:
Worksite Supervisor's Name:
Type of Incident: (Circle all that apply)
Injury Insubordination Early Departure Refusal Poor Work Performance
Failure to Obey Program Rules Influence of Alcohol/ Drugs
Other:
Date/Time of Incident:
Location of Incident
Witnesses: (Give name, address, etc. If program Worker use WRP#)
Description of Incident: (Give complete detailed account of incident. Describe any injury)
Action Taken By Worksite Supervisor: (Describe action taken. If no action taken, state "NONE")
I certify that the above stated information is true & correct to the best of my knowledge:
Date:
(Signature of Worksite Supervisor)
Action Taken By Work Release Staff: (WRP use only)
Officer: Badge# Date: