America for Election Transparency


Election Incident Report Form

Instructions: Please fill in the form as completely as possible as soon as possible after (or during) the incident. Take the time to collect names and contact details of other witnesses. If you collect electronic evidence (picture, video or audio recording), make a copy of the file and submit with your report, but retain the original on your phone or other electronic device.

REPORTER INFORMATION
*Reported by:
*Phone
*Email
*Position (voter, poll worker, poll watcher, etc)
DESCRIPTION OF THE INCIDENT
Date of incident
Time of incident (HH:MI AM/PM)
Were the police notified?
State
County/City
Address or location of the incident
Description of the incident (What happened, how it happened, etc. Be as specific as possible.
Is there electronic evidence of the incident?
What type of evidence is it?
Is the evidence in your possession?
Did you witness the incident?
Upload evidence here. You can upload a total of three files. If you have additional evidence, please indicate that below.
First file
Second file
Third file
Do you have additional electronic evidence?
WITNESSES
Name of Witness Phone
Role of Witness Email
Name of Witness Phone
Role of Witness Email
Name of Witness Phone
Role of Witness Email
Name of Witness Phone
Role of Witness Email
Additional Witness Comments
PARTIES INVOLVED IN THE INCIDENT
Name Phone
Role Email
Name Phone
Role Email
Name Phone
Role Email
Name Phone
Role Email
Additional Involved Party Comments
ADDITIONAL INFORMATION

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