Incident/Accident Report – York County Community College

112 College Drive
Wells, ME 04090 (207) 216-4413

YCCC Incident/Accident Report

Brief Incident Desciption(Required)

Date and Time the Incident Occurred(Required)

Involved Name(Required)

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who Was Involved?(Required)

Is there video or photos of the incident?(Required)

YES

Were the Police/Fire/EMS involved?(Required)

YES

Witness Name

First Last

Witness Phone #

Witness Email Address

Please describe the incident in detail.(Required)

Date and Time the Incident Occurred(Required)

Report Submitted By:

First Last

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112 College Drive
Wells, ME 04090 (207) 216-4413

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