Mission College Library Incident Report Form
Attach additional pages if needed
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Date of Incident Time of Incident
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Name of involved party Name of involved party
Description of Incident: __________________________________________________
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Witnesses (include contact information such as phone # and/or student I.D.):
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Campus Police Response: _________________________________________________
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Library Response: ________________________________________________________
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Submitted by ___________________________________ _______________________
Date submitted
RETURN ORIGINAL TO LIBRARY DIRECTOR
approved 11-17-04 librarians' meeting
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