Incident Report Incident Report Reporter's Name* First Last Reporter's Email* Reporter's Phone*Reporter's Association to Incident*Select OneVictimWitnessSecurityDate and time of report* Date and time of incident* Type of Incident*Select OneAccidentCrimeHate CrimeMedicalPublic SafetyRacismCampus*Select OneHaverhill (Main Campus)Liberty ChurchMaineGrand RapidsKentuckyTexarkanaLocation on campus* Description of Incident*Outside Agency Involvement*NonePoliceFireAmbulanceFamily / Child Services Δ
