INCIDENT JOURNAL

DATE: ________ PLACE OF OCCURANCE:___________________________

TIME: ________ IF INCIDENT BY PHONE WHAT NUMBER:_____________

WAS THE CALL RECORDED YES NO

IF SO, IS A TAPE AVAILABLE YES NO

PERSONS INVOLVED:_____________________________________________

WITNESSES (including address, telephone number and e-mail address if available):________________________________________________________________________________________________________________________________________________________________________________________

EXPLAIN EXACTLY WHAT OCCURRED:_______________________________

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POLICE NOTIFIED: YES NO

DHS NOTIFIED YES NO