KCEC, KCI & KCP Internal Safety Reporting

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Name *

First

Last

event been Person

Email *

Phone #

District #

I am reporting a

Person Reporting Incident *

First

Last

Name Person Involved in Incident *

First

Last

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