Report Exec Enterprise - Online Reporting



	Start	Incident Type	Person Info	Incident	Vehicle	Property	Digital Media	Review	Finish

Requestor's IP Address : 38.107.179.209

Select Report Type for

Please select the report type:Original or Supplemental.

Select

Report Type

Definition

Original

This is the first report you have filed for this incident.

Supplemental

You are adding information to a previous report which was submitted online.

Enter code at left:
Original Online Report Number:

Select Incident Type

Select

Incident Type

Definition

Examples

	Misc.	Reporting incidents not covered in the other four categories.	Litter, loud/bush parties, missing stop signs
	Nuisance Dog	Dogs creating public safety concerns.	Dogs roaming free. Dogs chasing people. Excessive barking
	Off-Highway Vehicles	Snowmobiles, All-Terrain Vehicles, quads	Problems with snowmobiles and ATVs - noise, trespass, stunting
	Traffic Safety	Public Safety concerns regarding traffic within Parkland County.	Speeding, Failing to Stop at Stop Signs, racing. Gravel trucks, overweight trucks or missing intersection signage.
	Unsightly Property	Any property with old dilapidated vehicles, trash, etc. If cannot be sighted from off property, not unsightly.	Residential property with 30 bags of garbage in yard. Residential property with 10 old rusted junker type vehicles.

Select Reporting Person Type
Please select a proper person type according to the definition below.
Select	Person Type	Definition
	Individual	If you are reporting this for yourself.
	Business	If you are responsible for reporting this for your employer or your own business.

Enter Reporting Person Information

Please enter your information as completely as possible. You may be contacted regarding this incident. An email address is required if you would like to be notified when this report is received and approved.

Person Type:

Employee ID:

First Name:

Middle Name:

Last Name:

Home Address:

City/State/Zip Code:

, ,

Home Phone:

Mobile Phone:

Email Address:

Email report to this address

Confirm Email:

Employer Name:

Work Address:

City /State /Zip Code:

, ,

Work Phone:

Race:

Sex:

DOB:

Driver License Number:

Licensing State:

Person Type	Name	Home Phone	Mobile Phone	Work Phone

Enter Incident Information

Please enter all the information that applies. If you do not know the address of the incident, use the nearest intersection such as Market St./ 10th St. Please ignore previous instructions. LB

Street Address:

City/State/Zip Code:

, ,

Incident Time (start):

Incident Time (end):

Have Vehicle Info to Enter?:

Yes No

Have Property Info to Enter?:

Yes No

Incident Description:

(Characters Left)

Enter Vehicle Information
Please enter the Vehicle information.
Type:
Make:
Model:
Year (YYYY) :
Color:
License Plate Type:
License Plate Number:	(do not enter spaces)
Licensing State:

Enter Property Information
Please enter the Property information.
OwnerShip:
Type:
Subtype:
Brand:
Model:
Color:
Serial Number:
How Many:
Approx. Market Value ($):
Property Description:

Select Digital Media
Please select any digital media (pictures, documents or any digital data files) that are relevant to this incident.

File Name	Title	Description

Review Report

Please review the report. If all the information is correct, click the Continue button to submit the report. If you need to modify some information, click the desired modify link. This will be your last chance to change information for this report.

General Information:

Incident Type:

Reporting Person Information:

Incident Information:

Incident Location:

Incident Time (start):

Incident Time (end):

Incident Description:

Vehicle Information:
Type:
Make:
Model:
Year (YYYY):
Color:
License Plate Type:
License Plate Number:
Licensing State:

Property Information:
OwnerShip:
Type:
Subtype:
Brand:
Model:
Color:
Serial Number:
How Many:
Market Value($):
Property Description:

Digital Media:

Your report has been submitted.

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