Appendix E: Incident Form
Fulton County Public Library
(Please send to the Director’s office when completed) ------------------Received by Director ________________Location: _________________________________ Date: ____________ Time: ___________
Description of Incident: ________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Description of Person(s) involved: ____________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Name/Address of Patron(s) involved: ______________________________________________ ___________________________________________________________________________
Witnesses: __________________________________________________________________ ___________________________________________________________________________
Action Taken: ___ Police Called ___ Supervisor notified ___ Person ejected from building ___
Other Please explain): _________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Name of responding officer: _______________________________________ Case # _______
Staff member making report - Signature: ______________________________
Additional Information: _________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
(Use reverse side of this sheet if necessary)