Date of Report: __/__/__

D M Y

Emergency Report Number: E-________

Officer(s) Preparing Report__________________________________

__________________________________

Area office__________________________________

This form is intended for reporting any developments which require the urgent attention of the central office or others higher in the structure. Please use supplementary sheets, if there is insufficient space. Also use supplementary sheets for any additional information not included in the questions -- indicating the source of information.

1. Introduction; highlights:

(Note the developments which requires attention. Try to be as specific as possible in regard to such questions as who, what, when, where, how, and why.)

2. Action taken by the area office to confirm the facts

3. Action taken by the area office to respond to the situation

4. Action taken by the authorities to respond to the situation

5. Further actions planned by the area office

4. Recommendations for action by the central office (Please specify the unit or individual to take action, if known)

5. Conclusions

(Please include any concluding remarks which would be helpful to the central office in dealing with the recommendations or information provided.)

6. Attachments

(Please append any documents, interview forms, or other materials which would help to explain the situation or recommendations.)

7. Approval by Coordinator

Area Office Coordinator: (Signed)

Date and time the report was forwarded to the central office:

Date: __/__/__ Time __________

D M Y