Reporter Information
This screen allows users to enter information about the person who initially reported the incident (as opposed to the person that filed the incident in EIM). If the users select the ‘Provider’ value in this field then the first name, last name and phone number fields will become mandatory.
Field Name |
Field Description |
Initial Reporter Type |
Select the type of individual who reported the incident, such as participant, advocate, friend, etc. |
Relationship to Participant |
Select the relationship that the individual who reported the incident has to the participant. |
If other, please specify |
If Other is selected as the relationship, provide an explanation. |
First Name |
Enter individual's first name who reported the incident. |
Last Name |
Enter individual's last name who reported the incident. |
Address Line 1 |
Enter the street address of the individual who reported the incident. |
Address Line 2 |
Enter the second line of the individual's address, if applicable. |
Address Line 3 |
Enter the third line of the individual's address, if applicable. |
City |
Enter the city corresponding to the above address. |
County |
Enter the county corresponding to the above address. |
State |
Enter the state corresponding to the above address. |
Zip Code |
Enter the zip code corresponding to the above address. |
Phone |
Enter the phone number of the individual who reported the incident. |
| Enter the e-mail address of the individual who reported the incident. |