Paul Sawyier Public Library Incident Report

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TYPE OF REPORT:
INCIDENT REPORT		ACCIDENT/MEDICAL EMERGENCY REPORT
TYPE OF INCIDENT:
FIRE	VANDALISM	SLEEPING	ASSAULT
THEFT	TRESSPASSING	LOITERING	INTOXICATION
OTHER
WHEN DID THE INCIDENT OCCUR?
DATE:    (mm/dd/yyyy)		TIME:     (example: 5:42 am)

WHERE DID THE INCIDENT/ACCIDENT OCCUR?
MAIN FLOOR	YOUTH SERVICES	GARAGE	OTHER
WHO WAS THE SUBJECT INVOLVED IN THE INCIDENT?
NAME:		PHONE:
ADDRESS:		LIBRARY CARD #:
STAFF:  YN		AGE:
HEIGHT:		WEIGHT:
HAIR COLOR:		SEX:    MF
CLOTHING:		TATOOS/SCARS:
RACE: CAUCASIANAFRICAN-AMERICANHISPANICASIANOTHER

WHAT WAS THE NATURE OF THE INCIDENT?

PLEASE PROVIDE DETAILS OF THE INCIDENT/ACCIDENT, INCLUDING DETAILS OF ANY INJURIES.

WITNESSES

NAME:	PHONE:
ADDRESS:	LIBRARY CARD #:
NAME:	PHONE:
ADDRESS:	LIBRARY CARD #:
NAME:	PHONE:
ADDRESS:	LIBRARY CARD #:
NAME:	PHONE:
ADDRESS:	LIBRARY CARD #:
NAME:	PHONE:
ADDRESS:	LIBRARY CARD #:

ACTION TAKEN

911
	FIRE DEPT
	POLICE
	AMBULANCE		TRANSPORTED BY AMBULANCE:   YN
POLICE ASSISTANCE (NOT 911)
SUBJECT REMOVED FROM BUILDING   YN