GSACPC Incident Reporting Form


Use this form to report:

  • Any incident involving a sensitive issue (discrimination, sexual harassment or abuse)
  • Any incident that was a near miss, something that could have been much worse or may have future implications.
  • Something needs to change.
  • Any incident involving injury
  • Any incident that involved illness
  • Any incident that involved a vehicular accident


This form will guide you through questions that relate to your type of incident. Please continue to the end.


Forms are saved in a secure and encrypted system only accessible by council risk management personnel.

 

Please check this box if the issue involves harassment, abuse, self-harm, racism, or anything you believe needs special care.

 

If you submit anonymously, we won't be able to follow up with you.

 
 

Reporting Person's Information

 
 
 
 
 
 
 

Incident Information

 
 

If more than four, please submit another incident report (After you submit, a new form appears).

 
 
 
 
mm/dd/yyyy
 

Please use 00:00 AM or PM

 
 

Please provide detail on where the incident occurred, for example, on the front porch or on the trail between the cabin and ramada.

 
 
 
 
 

(Vehicle Accident Only)

 

(Vehicle Accident Only)

 
 
Drop your files here