Incident Report
Name of person reporting the incident
*
First Name
Last Name
Phone Number or person reporting the incident
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email of person reporting the incident
*
example@example.com
Date and Time of Incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Type
*
alchohol/drug violation,
fight/altercation
medical emergency
Other
Specific Location of Incident
*
Parties Involved
*
Were the police contacted?
*
Yes
No
Was a police report obtained?
Yes
No
Was anyone arrested?
Yes
No
Was anyone injured?
*
Yes
No
Describe the injury:
Did EMS or Fire/Rescue respond?
*
Yes
No
Was anyone transported to the hospital?
Yes
No
Please provide a detailed description of the incident/concern using specific concise, objective language. DO NOT ENTER SEE ATTACHED. You may provide supporting documentation below. However, a description is required in this field.
*
Supporting Documentation: Photos, video, email, and other supporting documents may be attached. Attachments require time to upload, so please be patient after submitting this form.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: