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Incident Report
Please fill this in as soon as possible after the incident. All who are involved in the incident and are a part of F4F would need to fill this form out. Please submit one incident form per person per incident.
* Indicates required question
Email
*
Record my email address with my response
Last Name Of Person
*
Your answer
First Name Of Person
*
Your answer
Outreach or Survivor Care
*
Outreach
Survivor Care
Date Of Incident
*
MM
/
DD
/
YYYY
Time Of Incident
*
Time
:
AM
PM
Report Of Harm or Abuse
*
Yes
No
Nature Of Incident
*
Personal Injury
Physical Assault
Verbal Harassment
Damage to Personal Property
Volunteer Damaged Public Property
Option 6
Required
What Authorities Were Notified
*
Police
Paramedics
Establishment Manager, Bartender Etc
Fight4Freedom Staff
Fire Department
None
Required
Street Address
Your answer
City
*
Your answer
Meeting/Outreach Location (Club or Parlour etc.)
*
Your answer
Inside Establishment
*
Inside
On the street/Parking Lot
Full Names of Witness(es)
*
Your answer
Was First Aid Administered
*
Yes
No
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