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Safe Conduct Incident Report Form

Incident Report Form
First Church of Christ Congregational, UCC
2183 Main Street, Glastonbury CT  06033
(860) 633-4641

 

Date of Incident
Indicate if first aid was administered and if normal activity resumed.
Including information about the witnesses.
Names and phone numbers
Include the names.
Once you have determined that a report is necessary, please submit this form within 24 hours to the Pastors, the President or the program staff.
By submitting this form, you accept the Mollom privacy policy.