LOBC Incident Report

Date of Incident

mm/dd/yyyy

Your first & last names

Incident

Please describe what happened

People

List the individuals directly involved

Impact

Who was impacted as a result of this incident?

Just me

Those listed

Our church

The community

Outcomes

What was the action taken at the time of the incident, and the outcomes immediately following the incident?

Send me a copy of my responses

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