Incident Report Form

Use this form to report any information about an incident or concern. By submitting or signing this form, you are giving permission for the Education and Training Center at Pitt-Titusville to share this report with the actor(s) charged and other relevant parties who need to know the information. Completely record all information and submit report to the Office of the Executive Director of the ETC no more than eight (8) hours after incident or sooner if incident is serious or you are told that the report is needed immediately.