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Sample of SEIRS Reporting Form. What to include.

CREATE NEW INCIDENT REPORT FOR: (Please type – preferred - or print.)

DATE OF REPORT

USER NAME

USER EMAIL

USER PHONE

COUNTY

CHIEF JUDGE

ASSIST JUDGE (optional)


NARRATIVE FIELD (If you see something, say something to the Chief Judge. Write up the report regardless of whether the problem was corrected or not. Include the time of incident.)

Keep it factual, not emotional.

Example Factual: Judge's face turned red and said, "it is none of my concern. I rule and what I say goes." She threatened to throw me out.

Example Emotional: The Judge was really mad and got very huffy and nasty. She scared me.

Be polite and Be Right!


ADD CATEGORY (Optional. Helps us categorize incidents.)

Ballot

Curbside Voting

Election Staff

Electioneering

Equipment

Legal Issue

Other (Explain in Description.)

Security

Shutdown Procedures

Startup Procedures

Voter Registration

Voter Suppression/Obstruction

Voting Machine Set up and Testing


ADD STATUS (Regardless or whether the incident was resolved by the Chief Judge or not, please indicate below:

Assigned

Closed

Degraded Voting or Potential for Fraud - Closed

Degraded Voting or Potential for Fraud - Open

Disrupted or Fraudulent Voting - Open

Open

Priority

Problem Resolved

Processing

System Critical


WITNESSES? (Other observers/persons there who witnessed the incident? ALSO, ADD AS MANY WITNESSES AS YOUR LIKE)


WITNESS NAME

WITNESS PHONE NUMBER


ADD EXHIBIT FILES IF YOU HAVE THEM


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