Please fill this out to the best of your ability. Do not guess, assume what others may say, or interpret anything. We want to simply know what happened from your point of view.
  • The date the incident ocurred, not the day you are reporting on it.
  • Please indicate if this was a positive, negative or neutral encounter.
  • In one sentence, please describe the summary of this encounter. It can be as simple as "stepped on a nail", or "Joe made my day".
  • Please provide, to the best of your recollection and ability, a summary of the incident. Do not assume other peoples' intentions or thoughts, just tell us what happened from your point of view.
  • If you want to include pictures attach here.
    Drop files here or
  • IF you feel it is applicable, what do you feel would be an appropriate resolution to this matter? (NOTE: This does not mean that you proposed resolution will specifically happen)
  • Enter your email address ONLY if you want a copy of this report.