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County of Wayne Human Resources

hrinfo@waynegov.com

Document Signers
    • 1 Signer1

    • 2 Aaron Stryker

SeamlessDocs

The purpose of this form is to document events and circumstances surrounding
accidents or incidents with no injuries OR when an employee chooses not to go
to the doctor. Filling out this form does not waive the employee's right to a
future Workers' Compensation claim for the same injury. This form is for
documentation purposes only.
Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Signature HereAaron Stryker Will Sign Here
09/17/2021Click to Sign
Signature HereClick to Sign

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