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Report An Accident
Please Fill Out This Form. If you need to call, please call 570-550-2978
DETAILS OF THE PERSON IN ACCIDENT
CONTACT INFORMATION
ACCIDENT CLASSIFICATION
ACCIDENT DETAILS
Date of Accident
Have all IBEW locals been notified:
YES
NO
NOT SURE
FAMILY MEMBERS WE MAY CONTACT
ADDITIONAL INFORMATION
SUBMISSION DETAILS
Date Submitted: