Incident Report

Incident Report
Mailing Address: 364 Bateman Road, Barrington, IL 60010 | Phone: 847-783-6772

Email: office@bhillsparkd.org

Website: bhillsparkd.org

Rev 42016
Please complete this form to document an incident or situation. You also have the options to mail in a form, fax, or put in District mail box at the Riding Center. The Park District will contact you to acknowledge receipt of your report.
Location of Incident:*
Report Submitted by:*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Persons Notified:*
Were the Police Called?*

YesNo
Police Report Number:*
ReportSubmitted By:*
Description and Narrative of Incident:*
Name of Event or Group with which the event was associated:
Witness:
Phone Number

Area CodePhone Number
Witness:
Phone Number

Area CodePhone Number
Enter the message as it's shown*
Should be Empty: