| Meinders Community Library Board Policy | 700 | ||
| Policy: Behavior Incident Form | Originally Adopted | Next Review | |
| Current Version Adopted | January 9, 2019 | 6/2014 | November 2022 |
DATE: ____________________ TIME: ___________________
Name of Person(s) involved: ______________________________________________________
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Telephone of Person(s) involved: __________________________________________________
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Names, telephone numbers, addresses of witness(es): __________________________________
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Description of Incident: __________________________________________________________
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Name of Staff Involved: __________________________________________________________
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Action Taken by Staff: ___________________________________________________________
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Length of Suspension: ___________ Start Date: ______________ End Date: _____________
Were Police Called: ______________________
Name of Reporting Officer: ______________________________________________________
What action did Police take: ______________________________________________________
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Date report filed: _______________________________________________________________
Date Forwarded to Director: ______________________________________________________
Action taken by Director: ________________________________________________________
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Library Board Action Required: ___________________________________________________
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Additional Notes: