Phone number *
207-951-0530
Phone type Mobile Home Work Other
Date of Accident: 3/21/2026 *
3/21/2026
Time of Accident: *
10:45 am
Time of Accident: 10:45 am *
Ex: 3:45 PM
This accident was Bob Duane fell off a step ladder *
Select… Serious but not requiring medical attention Serious requiring medical attention Life-threatening minor
Specific location of accident: *
Hallway in front of Charles Morrow's office
What action was taken by HUMC? *
(select all that apply)
Further details about action taken by HUMC:
sat down, accessed by Bill Riley, EMT, given water, watched for a time
If applicable, how and when was the parent (or guardian) notified?
Person #1 who witnessed the accident: *
(Name & email address)Wayne
Phone number *
Phone type Mobile Home Work Other
Person #2 who witnessed the accident: *
(Name & email address)
Phone number *
Phone type Mobile Home Work Other
Any pertinent notes or details to add?
Submit
