SSA Incident Report

This report is designed to record and submit any incident of unwanted, unwarranted or inappropriate behavior by members or guests.

This form is submitted directly to the Office Manager and will be discussed with a representative on the Board of Governors. In some cases, the report will be escalated to the entire Board of Governors at the next board meeting during Executive Session. If you would like to make a report regarding SSA staff, please emai l the Commodore directly.

Name

The person filling out this report.

First Name

Last Name

Reporting As

Victim

Witness

Phone

(###)

###

####

Date of Incident

YYYY

Location of Incident

Name of Offending Party or Parties

Details of Incident

Please include names of all parties involved and describe the offending incident in as much detail as possible.

Action Taken

Do you wish to remain Anonymous?

Witness Names and Contact Numbers

SSA Incident Report

Severn Sailing Association