Incident Report

Please complete this report for any emergencies, conflicts or other incidents out of the ordinary involving customers or staff. Please provide as much detail about the occurrence as possible. Please forward the report to your immediate supervisor and the Director.

Date & Time (MM/DD/YYYY HH:MM AM or PM) *

Place of Occurrence *

Please describe the incident in detail, including an account of what happened, extent of injury (if any), cause of occurrence, and any contributing factors. *

Actions Taken: Select one and give a full description of patron’s activity and actions taken below. *

If you chose 'Other' above, please provide a brief explanation below:

Library Customers present or involved (please include name, address, and phone number if possible) *

Witnesses and other staff are encouraged to fill out a report as well.
A copy of the Library’s Conduct Policy was supplied to the person(s) whose conduct was the origin of this report. *

Yes

No

Staff Member Name *

Date Signed (MM/DD/YYYY) *

Hours & Location

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