What information does the Employee Incident Form request?

It requests the employee’s name and department, incident date and description, reporter details and phone number, and comments, actions, dates, and signatures for review.

Who completes the Employee Incident Form?

An employee reporting an incident provides the incident and reporter details. The form also includes sections for the employee and department head or committee chair.

Do I need a notary for the Employee Incident Form?

No. The form is signed and dated without a notary, and it lists no sworn attachment or other notarized step.

Staunton, IL · Macoupin County

No notary required

Employee Incident Form

Staunton employees use this form to report an incident and provide details for review by a department head or committee chair.

What this form is

The Employee Incident Form records an incident involving a Staunton employee and provides space for department-level comments and any action taken. The form asks for the employee’s name and department, the incident date and description, the reporter’s name, signature and phone number, and signatures and dates for the employee and department head or committee chair.

Who needs it

Staunton employees reporting an incident, and department heads or committee chairs who review the report, use this form.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This form is signed and dated without a notary; it lists no sworn attachment or other notarized step.

How to submit this form

1
Download The Form
Download the Employee Incident Form PDF.
2
Complete Incident Details
Enter the employee’s name and department, incident date and description, and reporter details.
3
Add Review And Signatures
Complete the applicable comments, action, date, and signature sections for the employee and department head or committee chair.
4
Submit To The City
Submit the form to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What information does the Employee Incident Form request?: It requests the employee’s name and department, incident date and description, reporter details and phone number, and comments, actions, dates, and signatures for review.
Who completes the Employee Incident Form?: An employee reporting an incident provides the incident and reporter details. The form also includes sections for the employee and department head or committee chair.
Do I need a notary for the Employee Incident Form?: No. The form is signed and dated without a notary, and it lists no sworn attachment or other notarized step.
How do I submit the Employee Incident Form?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Employee Incident Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.