ACTS Incident Report Form

Please report any incident which concerned you during your time with ACTS.

Incidents may include accidents, issues between volunteers, or issues involving a single or multiple dogs.

Your feedback is very important and allows us to gain an understanding of events that may present threats or general concerns.

An ACTS representative may contact you to follow-up, so please list a phone and email address.
Your Name
Email
example@example.com
Phone #
Date of Incident

MonthDayYear
Date
Person(s) Involved
Place/Location where incident occurred:
Dog(s) Involved
Details of what happened
Should be Empty: