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COF SHOP
Give
Lewisburg Incident Report
Your Name and Role
Your Email Address
Volunteer/Congregant Name (involved in the incident)
Volunteer/Congregant Contact Information
Did the incident happen at LCOF?
YES
NO
If not, where did it happen?
Date of the incident:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
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1912
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Year
1980
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2015
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2033
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2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
Description of incident (provide as much detail as possible, including sequence of events leading up to the incident)
Was the volunteer/congregant injured?
YES
NO
If yes, describe the injury.
Was medical attention necessary?
YES
NO
Any additional information needed?
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