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Incident Form

  1. Logo Top
  2. Incident Form: ERC, LL, Play in the Park, Other
  3. Type of Incident*
    Check all that apply
  4. Actor #1 Information
    The actor is the victim, aggressor, or other.
  5. Actor #2's information
    The actor is the victim, aggressor, or other.
  6. Parent or Guardian Information
    Complete if the actor is a minor.
  7. Ask "Where were you when this happened?"
  8. INCIDENT DESCRIPTION
    Use facts, describe details not feelings
  9. Ask who, what, where, when, and why from the patron. Say "Tell me what happened".
  10. Did you call EMS or Police?*
    You may pick more than one option.
  11. Give as accurate time as possible
  12. Give as accurate time as possible.
  13. Witnesses
    Attempt to collect information from three witnesses to the incident and describe their involvement in the final Witness Field.
  14. STAFF SECTION
    Reporting Staff should complete
  15. Does this incident require follow-up?*
  16. Describe what needs to be done such as send a suspension letter, call the parents, gather more information, etc.
  17. Leave This Blank:

  18. This field is not part of the form submission.