Merion Village Good Neighbor Agreement Incident Report

Merion Village Good Neighbor Agreement Incident Report

This form should be used to report incidents related to any local business with whom Merion Village residents have a current Good Neighbor Agreement. A list of businesses with a current Good Neighbor Agreement can be found on our website. The purpose of this report is to make the MVA aware of incidents and problems as they occur. The Merion Village Association has no legal authority to police or reprimand any business, regardless of the Good Neighbor Agreement. If you have a concern related to a business, please contact the business directly and the Columbus Police Department in the case of any legal violations or concerns, prior to completing this incident report. As always, if there is an emergency or a crime in progress, call 911 immediately.
Are You a Merion Village Resident or Business? *
Any private information provided on this form (you name, phone number, e-mail address and home address) will be received by the Merion Village Association but will not be shared with the business.
Your Business Name *
Your Name *

First Name Last Name
Your E-Mail Address *

Confirmation Email
Your Phone Number *
Your Current Address *

Street Address

Street Address Line 2

City State

Zip Code
Which Business is the Subject of This Incident Report? *
Date and Time This Incident Occured *

Month Day Year
Date Hour Minutes AM/PM Option
Please Describe the Incident That Occurred on the Above Date *
Did You Report This Incident to the Business Directly? *

NO YES
Please Provide Any Details Related to the Report You Made Directly to the Business *
You can include details about how you made the report, who you spoke to or contacted and whether or not you received a response.
Did You Report This Incident to the Columbus Police Department? *

NO YES
Please Provide Any Details Related to the Report You Made With the Columbus Police Department *
You can include details about how you made the report, any report number that may have been issued and whether or not you received a response.
Did You Report This Incident to 311? *

NO YES
Please Provide Any Details Related to the Report You Made With 311 *
You can include details about how you made the report, any report number that may have been issued and whether or not you received a response.
Please Upload Any Supporting Documentation You Would Like to Share

Choose File(s) to Upload

Cancel of
Should be Empty: