Mile City Incident Report

Name Of Those Involved*
Date*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Incident Description*
Action Taken*
Volunteer*
Witness
I am aware of the incident which occurred on the stated date and time and agree with the action taken by Mile City Church.
Electronic Signature of Individuals Involved*
Date
MM slash DD slash YYYY
Electronic Signature of Director*
Date
MM slash DD slash YYYY
*A Director must sign all incident reports. If the Director is away from the building, please contact safety to locate another Mile City Church Director/Staff member to sign.