Blain Elementary School | Ssc Employee Portal

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Incident Report
(Blain Elementary School)

132 Blain Rd, Blain, PA 17006

Please take a moment to fill out the form.

Date

Time

Location of incident

Incident type

If you selected Others

Report prepared by (ENTER YOUR FIRST AND LAST NAME)

Name of Victims/Subject/Suspect

Name of the SSCI Officers

Department/Agency

Name of Emergency Personnel (i.e PD. Officer Smith)

What took place (Who, what, where, when, why and how?) PLEASE PUT IN DETAILS WHAT HAPPENEDD IN 3RD PERSON?

Other Pertinent Information:

Photo

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Thanks for submitting!

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