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Supervisor's Investigation Report

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    2. City of Gadsden Supervisor's Report Form
    10. Section A - WORKER'S COMPENSATION
    24. Did employee ask to see a doctor?
    27. Was employee released to return to work?
    28. If so, attach copy of release; if not, attach copy of disability certification.
      NOTE: NO DISABILITY IS PAYABLE UNLESS AUTHORIZED BY DOCTOR.
    32. Section B - VEHICLE ACCIDENTS
    37. City Vehicle:
    50. Other Vehicle:
    60. Section C - POTENTIAL LIABILITY CLAIM
    62. Type Claim:
    73. Section D - DAMAGE TO CITY PROPERTY