ECR App

Investigation Report

"*" indicates required fields

Reporting Staff*

First Last

Job Title*

Choose Your Direct Supervisor*

Direct Supervisor Role*

Time*

Date of Incident*

Location of Incident*

Name(s) of Child/Children involved.*

Please include the first name and last name of each child affected. Separate names by a comma.

Others Affected*

Please include the first name and last name of each person affected. Separate names by a comma.

Witness(es)*

Please include the first name and last name of each person affected. Separate names by a comma.

Description of Incident*

Please provide a detailed description. Please do not go over 700 characters.

Action Taken*

Please provide a detailed description. Please do not go over 700 characters.

Chose Your Case Manager*

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