Election Incident Report Report submitted by (First Name) Report submitted by (last name) Phone Number Email Address Date of Incident Did you observe the incident? Did you observe the incident? Yes No What was your postition when you observerd/heard about the issue? What was your postition when you observerd/heard about the issue? Poll Observer Precinct Election Official Reporting Poll Voter In What County did the Incident occur? Where did the issue occur? Where did the issue occur?Board of ElectionsPolling LocationSomewhere else Address / Precinct Name where incident occured What was impacted? Check all that apply. What was impacted? Check all that apply. Ballots Equipment Access Equipment Voter Issue Other Describe Incident Do you want to file a formal complaint if the option is available? Do you want to file a formal complaint if the option is available? Yes No 1 + 9 = Submit