Incident/Accident Report
Please fill out all fields below. Incident/Accident Reports must be submitted immediately following a church service
Date of Incident
Names of Persons Involved
Officials Notified
Individuals Present or Witnesses of the Incident/Accident (separate by commas)
Description of Incident (include what led up to the event, what interventions were used, who was contacted, description of person(s) involved, including make/model of vehicle(s), license plate(s), name(s), description of person(s).
Result of incident (How was the incident resolved?)
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