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Incident Report - YMCA of Youngstown, OH
This form is to be used for the purpose of reporting behaviors that do not align with the principles and practices of the Y. This includes things like harassment, suspected child abuse, or sexual misconduct. The option to remain anonymous is available at the bottom of the form. Thank you for reporting.
Select your branch
Please Select
Central YMCA
Davis Family YMCA
Camp Fitch YMCA
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Involved Parties
Name
First Name
Last Name
Who?
Member
Participant/Camper
Guest
Employee
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name
First Name
Last Name
Member ID
Who?
Member
Participant
Guest
Employee
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name
First Name
Last Name
Member ID
Who?
Member
Participant
Guest
Employee
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Infraction
Improper language
Inappropriate contact
Intentionally ignoring rules and policies
Drugs
Weapons
Fighting
Theft
Unauthorized entry of member or guest
Disrespecting staff and/or members
Sexual Harrassment/Abuse
Other
Describe in detail what happened.
Injuries
Yes
No
Were police called?
Yes
No
Was a police report filed?
Yes
No
Witnesses
Name
Phone Number
Witnesses
Name
Phone Number
Witnesses
Name
Phone Number
Person completing report
Name
Date
Would prefer to remain anonymous?
Remain Anonymous
Submit
Should be Empty: