D.M.E.C.S. Security Department Incident Report

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Incident report issued by:* This field is required.
Mr/Ms/Mrs
First Name
Middle Name
Last Name
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Your Position with the Ecclesiastical Order?* This field is required.Please tell us what position you hold with this ministry.
Please Select
Please Select
Dean
Professor
Adjunck Professor
Security Officer
Director
Manager
Program Manager
Patient- Client
Caregiver Manager
Caregiver
Live-in Caregiver
Instructor
Student-Local Church
Student-Online
Student-On site
Contractor
Other Vendor
Guest-Visitor
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Terms and Conditions* This field is required.By starting this report you understand that an official investigation will be conducted and that local law enforcement , may be called in to assist with any review of the alleged activities. You also understand that all reports submitted on the weekend or holidays will be open on the next business day of operation. You further understand that the first forty-eight hours (48) of your report is a cooling period in which (unless the incident is an emergency) no investigation will be conducted and that you have this time to pull the report back. Pulling a report back do not limit the action of our staff to investigate nor remove the file. It allow for your portion to be closed to any applicable public action. All reports submitted are held under strict privacy & confidentiality. All investigation report are completed within twenty-four months or within the applicable status of limitations for the reported matters. You also agree to all term and condition to cooperate with the investigator(s) and not to provide any false or misleading information while the investigation is being conducted. Any violation upon using this form you agree to a fine of not more than $500,000.00 (five hundred thousand dollars) and a confession of judgment within any court.
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Report date and time:* This field is required.
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Month
Day
Year
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Your official Employee ID Number.* This field is required.This will be your number on your executive order.
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Date and time when incident occurred:* This field is required.
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Month
Day
Year
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Hour
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Minutes
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PM
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Your Email* This field is required.Please ensure we can contact you by this email given.
example@example.com
Email Verified
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Supervisor Names
Mr/Ms/Mrs
First Name
Middle Name
Last Name
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Incident Location (Please provide specific details):* This field is required.
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Nature of incident* This field is required.
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Incident details* This field is required.
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Any Supportive Evident(s).Please provide initial copy of any evident you may have to support the incident.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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What motivated the incident? (if applicable)
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Was a report of the incident issued to the local police?* This field is required.
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Has anyone been arrested so far in relation to the incident?
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Type any victims with names, and contact information.* This field is required.
Just name, email or phone only
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Type any applicable witnesses with contact information.* This field is required.
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Full Name
First Name
Last Name
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Phone Number
Area Code
Phone Number
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Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Do you want the police to get in touch with you?* This field is required.
Yes
No
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Your official current and location of incident* This field is required.If you are not an security officer, please place your current location, department head and/ Pastor names, within the box below.
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Date you signed this report.
Date
Year
Month
Day
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Certification of the above Statement* This field is required.
I certify that I am a employee, official volunteer, or officer of the Daniel Matthew Ecclesiastical College System or the World Council of the National Assembly of Churches. I understand and further agree to the confession of judgement of a fine ($1,300 to $500,000.00) for any false, misleading information in connection to or within this report. I further states that the above information is true and correct. I now sign this under the penalty of perjury.
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SignatureYour Signature stand as proof of the certification of the above statement. You agree to all terms and conditions.
Clear
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YOUR FILE NUMBERPlease use this number when requesting information about your case.
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Please verify that you are human* This field is required.Let ensure that you are a real person.
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Unique ID
Should be Empty: