Incident Report

Incident Report
Mailing Address: 364 Bateman Road, Barrington, IL 60010 | Phone: 847-783-6772

Email: office@bhillsparkd.org

Website: bhillsparkd.org

Rev 42016
Please complete this form to document an incident or situation. You also have the options to mail in a form, fax, or put in District mail box at the Riding Center. The Park District will contact you to acknowledge receipt of your report.
Location of Incident: *
Report Submitted by: *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Persons Notified: *
Were the Police Called? *

Yes No
Police Report Number: *
ReportSubmitted By: *
Description and Narrative of Incident: *
Name of Event or Group with which the event was associated:
Witness:
Phone Number

Area Code Phone Number
Witness:
Phone Number

Area Code Phone Number
Enter the message as it's shown *
Should be Empty: