Incident report

Use this form to document incidents.

Required Actions:
Notify the Person-In-Charge immediately when an incident occurs
Complete this form within 1 business day of the incident

What Happens Next:
The Library Director or Assistant Director will inform staff of the incident. Identifying information will only be shared if necessary for safety purposes.

Important Note: Do not use this form for accidents. Use the designated patron accident report or staff accident report forms instead.

Staff member submitting the report*
First Last
PIC on Duty Notified of Incident*
First Last
Patron name
First Last
Patron description
Time*

: Hours

Minutes

AM/PM
Date*
MM slash DD slash YYYY
Location*
If applicable, list the relevant library policy(ies) that were being violated
Describe the incident in as much detail as you can, with specific actions and conversations, if possible*
Witnesses names and contact information
Emergency reponders notified*
If law enforcement involved, document case number
Blood borne pathogen supplies
Please indicate whether you've utilized any items from the large plastic tub. We'll replenish any supplies as necessary.