Fillable Online INSURED LOCATION Name & Location of 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name & Location of Incident' in the designated field. This is crucial for identifying where the incident occurred.
3. Fill in the 'Date' and 'Time' of the incident accurately to ensure proper documentation.
4. Complete the section for the 'Name of Employee Completing This Report,' including their telephone number, title, and email address for follow-up.
5. If applicable, provide details about the injured party, including their name, address, date of birth, and nature of injuries. Be as specific as possible.
6. For property loss or damage, fill out the property owner's information and describe any damages thoroughly.
7. List any witnesses or involved staff members with their contact information to support your report.
8. Finally, review all entries for accuracy before sending completed forms to claimintake@mpie.org or faxing them to 616-828-0111.

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