Incident Report
Please fill out all information below with as many details as possible
Date and Time of Occurrence
Your Name:(Person making the report)
Your Email:
Involved Employees and Witnesses
Police Department Information
Nature of Incident
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Authorization to Permanently Ban
Customer Issue
Disturbance
False alarm
False identification
Injury
Invalid Identification
Property damage
Quantity limitations violation
Security Issues
Theft
Threats
Underage sale
Other
Body Part Injured:
Other (Explain):
Location:
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15th Street/Highlands
Aurora
Bellingham
Chief
Colfax
The General
Home Office
Holliston
Jefe
Lynn
Prez
S.Broadway
Worcester
Summary of Incident:
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