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United Methodist Church 501 Hampton Lane (Beltway Exit 27B & Dulaney Valley Road) email: towsonumc@towsonumc.org Towson, Maryland 21286 410-823-6511 Elevator is available to access all 3 floors! .
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APPENDIX L
POLICY OF THE TOWSON UNITED METHODIST CHURCH FOR THE PREVENTION OF ABUSE OF CHILDREN AND YOUTH
ACCIDENT/ INCIDENT REPORT The Towson United Methodist Church
Date: ___________________________________ Time: ___________________________________________
Name of involved person:_____________________________________________________________________
Location of incident: _________________________________________________________________________
Program or event: __________________________________________________________________________
Description of stated or visible injury:____________________________________________________________
Description of how incident occurred: ___________________________________________________________
Supervisor of event at time of incident: ___________________________________________________________
Witness(es) to incident: ______________________________________________________________________
Procedures followed: ________________________________________________________________________
Other pertinent information: ___________________________________________________________________
Name of person completing Incident Report: ______________________________________________________
Phone Number: ________________________________________
TO BE COMPLETED BY APPLICABLE DIRECTOR OR SENIOR CLERGY
Reported to Director or Senior Clergy:
Date: ______________________________________________ Time: _________________________________
Summary:_________________________________________________________________________________
Contact with involved person’s Parent:
Date/time: ________________________________________________________________________________
Spoke with:
Summary:_________________________________________________________________________________
Contact local children and family service agency (if necessary):
Date/time: ________________________________________________________________________________
Spoke with:
Summary: ________________________________________________________________________________
Contact local law enforcement agency:
Date/time: ________________________________________________________________________________
Spoke with:
Summary:
Other contacts:
Name: ___________________________________________________________________________________
Date/time:
Summary:
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