HomeMy WebLinkAboutCity Council Committees - Civil Services Commission - 08/01/1992 CITY OF KENT
EMPLOYEE'S ACCIDENT/INCIDENT REPORT
This report is to be completed by the employee involved in the
accident/incident that is being reported. Information is to be recorded
immediately and all forms forwarded to the employee's supervisor to be sent
with supervisor's investigation report. -;
Name(s) of person(s) , Involved Age Address Phone
1 MCYICAR, Steyen C. 47 220= 4th. Ave s. , Kent 854-3315
2. see collision report fnr aAd,
3.
Date of Accident/Incident 7j31 /g2 Time 1801
Vehicle No. 352 ( If Applicable)
Location (be specific ) W. James 8 no W-achinntnn
Describe in detail what happened: i ac in s/F/ rnrR 'An@ OR A wash4~ ~~ at
light with no cars in front of me. Traffic was-Tnoving from east side of intersection
left turn w/b James to s/b. Washington) . A late 60's Dodge burned it's tires and accel -
erated rapidly ii loo§d -to west witR a,n in =,oE r d ��^�p A.All Aippreaehi g traffic
I decided to pursue reckless vehicle As i accelerated, i reached for amergopqi lights
and siren. I saw e/b vehicle only -mom _if hQ—hid a green
l�as y ur not equipped with seat belts? (If Applicable) ypc.
Were you wearing the seat belt? ( If Applicabl.e) Me-
USE
USE REVERSE SIDE OF THIS FOPM TO- PROYIDE DIAGRAM OF COLLISION
see Collision Report 92-6459 for details
What corrective measures, or assistance (if any) did City Employees take:
I assisted at collision scono , t•i ' al of fig-aid-an+_
WITNESSES:
Name: �uwrUL�+ P . Dept./Address: (:2aL--z-c Phone:--:?RPported by: t�_��x��L / cvl�sflgpartment: o t `
• Supervisor: Date: R !t ZyZ
. SIGNATUP.E
0322W-11W Rev. 01/87