|
Policy
Download a Word Document copy of the Incident Report HERE
FANWOOD MEMORIAL LIBRARY INCIDENT REPORT
Complete the following report for any accident/injury involving a patron occurring on Library premises.
IMPORTANT: This report should be sent or presented to the Library Director or library representative within 24 hours of the accident/injury.
Date: ____________________ Time: ____________________
Name: ____________________________________________________________
Address: __________________________________________________________
Phone: __________________________ Email: __________________________
Location of incident: ____________________________________________________________
Describe Event: _______________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Were the Police or Rescue Squad summoned: _________ Was a Police Report Filed:_________
Staff Members Present at time of Incident: __________________________________________
___________________________________________________________________________
Eyewitnesses to accident:
Name Age Address Phone No.
__________________________ ______ __________________ ____________________
__________________________ ______ __________________ ____________________
Name of person completing form: ________________________________ Date: ___________
Additional information or comments:
Board of Trustees
Approved: June 8, 2009
Revised:
|