Park County, MT · Park County
Incident Report
Employees use this incident report to document an injury, property damage, near miss, unsafe condition, or other workplace incident for county review.
At a glance
- Issued by
- City of Park County · Park County, Park County, Montana
- Notarization
- Not required: file this form without a notary.
- Official source
- parkcountymt.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The report records the incident number, supervisor, date, time, and incident type, along with employee and witness statements. It also asks about equipment, other contributing factors, and corrective actions, and includes spaces for completion and review signatures. The form does not state when the county requires it or identify a filing department.
Who needs it
Employees completing an incident report can use this form to record incident details, statements, contributing factors, and corrective actions.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This report is signed and dated without a notary; attach equipment history, including maintenance schedules and engineering changes, if applicable.
How to submit this form
- 1
Download the Report
Download the Incident Report PDF.
- 2
Complete the Report
Fill in the incident details, statements, equipment information if applicable, contributing factors, and corrective actions.
- 3
Gather Equipment History
If applicable, attach equipment history, including maintenance schedules and engineering changes.
- 4
Sign and Submit
Complete the signature and date fields, then submit the report to the county department named on the form.
Frequently asked questions
- What does the Incident Report record?
- It records incident details, employee and witness statements, equipment information, other factors involved, and corrective actions. It also includes spaces for report completion and review.
- Do I need a notary for the Incident Report?
- No. The report is signed and dated without a notary. If equipment was involved, attach its history, including maintenance schedules and engineering changes, if applicable.
- How do I submit the Incident Report?
- The form does not provide submission instructions or name a filing department. Submit it to the county department named on the form; check the county website for current contact details.