Juror Incident Report Form

Notifying security about a potentially dangerous incident is important

This form can be used by jurors and the public to report non-emergency safety or security issues observed in or around the King County campus in downtown Seattle. It is not intended for emergency response. If you need immediate assistance from law enforcement or medical personnel, call 9-1-1.

Reportable incidents are not limited to law violations and may include any act or circumstance that interferes with individuals who have business with the county, individuals reporting for court or jury summons, or issues that adversely impact county facilities or equipment.

Use this form or go to www.kingcounty.gov/incidentreport on a mobile device. A photo upload option is available.

First Name

Last Name

Address

City

Zip

Phone

Date and Time of Incident

Location of Incident

What Happened?

Were there other witnesses?
If yes, please enter their name and contact information (if known)
Yes No

Was anyone injured?
If yes, what action was taken? (if known)
Yes No

By entering my initials in the box below, I certify that I have reviewed this report and believe it to be true and accurate to the best of my recollection. Further, I understand that this information may be used as legal documentation.

I would like to be contacted by King County for follow-up. (Check if yes.)

Initials

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Juror Incident Report Form

Notifying security about a potentially dangerous incident is important