NLR Public Library System

This form is to be used by staff to record information about problem or unusual incidents in the library or on library grounds. Types of problem incidents may include cases of intentionally excessive noise or raucous behavior, loitering, public intoxication, sexually related overtures, vandalism, fires, theft, physical violence or the threat of physical violence or any other disturbances. Unusual incidents may include accidents or illness, police or fire department activities, bomb threats, car accidents or towing. Fill in as much of the form as appropriate.

Branch Location:

Staff Name:

Please enter your full name!

Date:

Time:

Nature of Incident

Summary:

Offender

Name:

Age:

Library Card:

Phone Number:

Address:

City:

State:

Zip:

Affected Patron

Name:

Age:

Library Card:

Phone Number:

Address:

City:

State:

Zip:

Action Taken

Witness

Witness:

Library Records, by law are confidential and cannot be released to anyone other than the patron without a court order. I understand that while I am participating in this program a reading history for my account will be maintained for selction purposes

Reading Challenge Entry Form

Laman Library

9:00am - 1:00pm

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Argenta Library

9:00am - 6:00pm

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Reading Challenge Entry Form

Date Range

Create Account

Incident Report

Nature of Incident

Offender

Affected Patron

Action Taken

Witness

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Laman Library

Argenta Library

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Homebound Application

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