Kitsap Aces Incident Report
Date of Incident
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
*
Type of incident (please check box below)
*
Equipment Damage
Member Conflict
Consent Violation
Other
Reported by
*
Kitsap Aces Membership #
Email
*
example@example.com
Your role in the event
*
The reporting person
Participants 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.
*
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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