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Incident Report (The Co-op)

226 East Nittany Ave, State College PA, 16801

Please take a moment to fill out the form.

Date (MM/DD/YYYY)

Time (00:00am/pm)

Location of incident

Incident Type

If you selected Others

Report prepared by (ENTER YOUR FIRST AND LAST NAME)

Name of Victims/Subject/Suspects

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 HAPPENED IN 3RD PERSON?

Other Pertinent Information:

Photo

Videos

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Thanks for submitting!

stadesse@sscsecurity.com

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