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THIS FORM CAN BE USED TO MEET THE REPORTING REQUIREMENTS FOR ACCIDENT, I INJURY, ILLNESS, HOSPITALIZATION, EMERGENCY ROOM TREATMENT, DEATH OR FIRE.
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This form provides only a brief description of the incident and does not guarantee that no charges will be filed or that the complaint will be resolved. The City of Lake Elsinore regrets any inconvenience or concern regarding the submission, selection and use of this form. The City of Lake Elsinore cannot guarantee complete or accurate data from this online tool. Lake Elsinore can help with any information about the incident. Please contact the City of Lake Elsinore at: Please select all that apply. I am the complainant. I understand the online tools allow you to enter only one incident each; however you may make as many responses as necessary. Furthermore, I understand that the complaint form may be used only by a City of Lake Elsinore employee who is the complainant.

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