KCEC, KCI & KCP Internal Safety Reporting

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Name *

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Last

Email *

Phone #

District #

Please event to

I am reporting a

Person Reporting Incident *

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Name Person Involved in Incident *

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Date and Time of incident

Date

Time

Location of Incident

Please describe the event in detail

Remarks

Was damage done to the property?

Could this incident have been avoided?

Phone: (575) 758-2258
118 Cruz Alta Road • Taos, NM 87571

Phone: (575) 758-4838
116 Cruz Alta Rd • Taos, NM 87571

Phone: (575) 758-7757
201A Cruz Alta Rd • Taos, NM 87571