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INCIDENT REPORT - United States Army

INCIDENT REPORT12. What actions, if any, could have been taken to prevent this INCIDENT from occurring?For use of this form, see AR 40-68; the proponent agency is : See page 2 for instructions in completing this form and definitions of terms marked with an asterisk (*).PREVIOUS EDITIONS ARE OBSOLETEDA FORM 4106, FEB 2004 Page 1 of 2 Privacy Act of 1974, 5 USC 552a governs access to this Management Document under 10 USC 1102. Copies of this document, enclosures thereto, and information therefrom will not be further releasedunder penalty of the law. unauthorized disclosure carries a statutory penalty of up to $3,000 in the case of a first offense and up to $20,000 in the case ofa subsequent offense.

Unauthorized disclosure carries a statutory penalty of up to $3,000 in the case of a first offense and up to $20,000 in the case of. ... Staff Member Visitor. Volunteer Other. No harm*sustained Harm sustained. 9. Witness(es) who may be able provide additional detail concerning this incident. Laboratory Related.

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