Incident Reporting Incident Overview Date of Incident (required) Time of Incident (required) Location in Library (required) Reported by (required) Incident Type Type of Incident (check all that apply) (required) Patron Injury Patron Behavior Verbal Altercation Physical Altercation Medical Emergency Theft/Property Damage Trespassing/Removal Welfare Concern Other If OTHER, please describe Was law enforcement contacted? (required) Yes No Was 911/EMS contacted? (required) Yes No Patron Information Patron Name (if known) Cardholder? (required) Yes No Unknown Library Card (if known) Patron Description Was the patron asked to leave? (required) Yes No If YES, how long? If YES, did they leave voluntarily? Yes No Was a TRESPASS notice issued? (required) Yes No If YES, Officer Issuing Tresspass Description of Incident (required) Were there witnesses? (required) Yes No Witness name(s) and contact information: Any patrons/staff injured? (required) Yes No If YES, describe injuries Was first aid administered? Yes No n/a Attach photos or documentation Follow-Up Was the Library Director notified? (required) Yes No If YES, date and time Additional follow-up needed (required) Contact Patron Update Patron Record Review Security Footage File Police Report No Further Action Needed Other If OTHER, please describe Certification Reporting Staff Name (required) Staff Email (required) Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
