Kitsap Aces Incident Report
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Month
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Day
Year
Date
Time
Type of incident (please check box below)
Equipment Damage
Consent Incident
Consent Violation
Other:
Type of incident (please check box below)
Reported by
Role in the event
The reporting person
Kitsap Aces Membership #
Participant Involved
Participant Involved
Participant Involved
Participant Involved
Participant Involved
Participant Involved
Describe the incident
How have you been affected by the incident?
Have you taken legal action and if so, when was it reported?
Analysis: What do you think caused or contributed to the incident?
Signature - DISCLOSURE: by signing this form, you are accepting that details of the incident may be shared with Kitsap ACES board of directors or a third party mediator to resolve this matter.
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Date
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Year
Date
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