FORM 4-C (ELECTRONIC) · INCIDENT REPORT AND RECORDS REQUEST

Submit a Report

Use this form to report an object that does not behave as expected, or to request a copy of a public record. Fields not needed for your type of submission may be left blank.

Transmission notice

Submissions made through this portal are not transmitted, stored, or retained.

Type of submission

Record requested

TLO record no. Shown at the top of each case file. For requests only.

Where the object was found

A record number is not required. Describe the place as you would to someone from the town.

Town

Building / Site For example: Building 4, the pharmacy, the park.

Floor or Area

Room / Spot

Landmarks or directions

Date and time observed Times are local.

Description Describe what the object did, or what you are requesting. Do not describe anything the object gave you personally; attach that to a separate report.

Did the object produce, change, or give anything? Yes No Pending

Describe any activity from the object Optional.

Name Optional. Anonymous submissions are accepted.

Certification I certify that this submission is accurate to the best of my knowledge, and that I have not thanked the object.

Submit a Report

Form 4-C (Electronic): Acknowledgement