CALIFORNIA MUSIC AND CULTURE ASSOCIATION, INC [CMAC]
INCIDENT REPORT FORM
PLEASE KEEP A COPY OF THIS COMPLETED FORM IN YOUR FILES AND MAIL A COPY TO
CMAC, c/o Hinman & Carmichael LLP, 260 California Street, # 1001, San Francisco, CA 94111
INCIDENT REPORT FORM
PLEASE KEEP A COPY OF THIS COMPLETED FORM IN YOUR FILES AND MAIL A COPY TO
CMAC, c/o Hinman & Carmichael LLP, 260 California Street, # 1001, San Francisco, CA 94111
The purpose of this Incident Report Form is to create a database of interactions between ABC licensed venues and officers from the ABC and/or the SFPD and other enforcement agencies (i.e., Entertainment Commission, SFPD, Human Rights Commission, etc.). The information will be used to document the scope and purpose of enforcement actions in order to further the education and training of the licensed venue community and to assist in the development of venue operating standards. The information will also be useful in the defense of a venue against a criminal charge or an ABC Administrative Accusation proceeding.
DATE: ___________ TIME: _________ VENUE: _________________
ADDRESS OF VENUE: ______________________________________
ABC LICENSE TYPE: __________
SF ENTERTAINMENT PERMITS: ________________________________
WEATHER CONDITIONS: ______________________________________
SIDEWALK AND EXTERIOR CONDITIONS [TRAFFIC, PEDESTRIANS, LINES, CROWDS, ETC.]:
_________________________________________________________________________________
1. DESCRIBE INCIDENT [NARRATIVE, USE ADDITIONAL SHEETS IF NECESSARY]:
_________________________________________________________________________________
2. NAME OF PERSON ARRESTED/STOPPED/QUESTIONED [INCLUDE ADDRESS/PHONE/EMAIL ADDRESS]:________________________________________________________________________
3. PHYSICAL DESCRIPTION OF PERSON [AGE, HEIGHT, WEIGHT, HAIR/EYE COLOR, DRESS]: __________________________________________________________________________________
4. WAS IDENTIFICATION ASKED FOR? ________ WAS IDENTIFICATION SHOWN? ___________
5. DESCRIBE IDENTIFICATION [TYPE, PHYSICAL DESCRIPTION, AGE SHOWN, ETC.]
____________________________________________________________________
6. DID INDENTIFICATION MATCH PERSON? ____________________________________________
7. STATEMENTS OF PERSON [USE ADDITIONAL SHEETS IF NECESSARY]: __________________________________________________________________________________
__________________________________________________________________________________
8. NAME, AGENCY AND BADGE [STAR] NUMBER OF OFFICER: ___________________________ __________________________________________________________________________________
9. DESCRIPTION OF OFFICER [AGE, HEIGHT, WEIGHT, HAIR/EYE COLOR, DRESS (UNIFORM OR PLAIN CLOTHES)]: _______________________________________________________________________
10. OFFICER STATEMENTS [USE ADDITIONAL SHEETS IF NECESSARY: __________________________________________________________________________________ __________________________________________________________________________________
11. CRIMINAL OR ADMINISTRATIVE SECTION CITED BY OFFICER AS BASIS FOR ACTION: _____________________________________________________________________________
12. DISPOSITION OF MATTER [ARREST AND IN CUSTODY, WARNING, CITATION OR NO ACTION – ATTACH COPY OF CITATION IF ONE ISSUED]: ___________________________________________________________________________
13. WAS INCIDENT VIDEOTAPED BY SECURITY CAMERAS OR PERSONAL CELLPHONE (IF YES, WHERE IS COPY OF VIDEO?]: _____________________________________________________________________________
14. WAS ANY TESTING EQUIPMENT USED BY OFFICERS [NOISE METERS, ETC.]? IF SO PLEASE DESCRIBE:
_______________________________________________________________________
15. WERE YOU FURNISHED WITH COPIES OF TEST RESULTS? [IF SO PLEASE ATTACH]:_______________________________________________________________
16. PLEASE DESCRIBE YOUR ASSESSMENT OF THE OFFICERS [POLITE? THREATENING? PROFESSIONAL? OTHER?]: _______________________________________________________________________
17. DID THE OFFICERS ASK TO COME IN OR DID THEY JUST ENTER?
_______________________________________________________________________
18, DID YOU OR ANY MEMBER OF YOUR STAFF INVITE THE OFFICER TO ENTER?
ANY OTHER INFORMATION THAT IS RELEVANT [I.E., PRIOR EXPERIENCE WITH OFFICER, PRIOR INCIDENTS WITH OFFICER, HISTORY OF PRIOR CITATIONS, ETC.]:
__________________________________________________________
Person completing form:
name: ________________________________
title: __________________________________
venue: ________________________________
cell: _________________________________
email: ________________________________
reviewed by: _____________________(owner)
I like it as a starting base.
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