Wells & Associates, LLP

200 prospect street

E a s t S t r o u d s b u r g , pa 1 8 3 0 1
W e l l s l l p. c o m

Employee Incident Report

Date

Employee Manager
Name Name
Title/position Title/position

Incident
Date
Time
Location

Description of incident (if additional space is needed, use page 2)

Employee explanation (if additional space is needed, use page 2)

Witnesses

Action to be taken
 Verbal warning  Probation  Dismissal
 Written warning  Suspension  Other
Explain rationale

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information contained herein.

Employee Manager

Date Date
WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1
WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2