Vermont Adult Protective Services Report







If this is a report from a staff member at a facility, please fill out using facility information.  If the reporter is not part of the facility, the facility information should not be used. If this is a report from a staff member at a facility, please fill out using facility information. If the reporter is not part of the facility, the facility information should not be used.
Anonymous Report?
Date of Birth

In this section, you will describe what caused you to fill out a report on the alleged
            victim.  If anyone saw the incident happen, you will need to add their contact information
            to the Other Participant Section.  Please answer as many of the following questions as you can. In this section, you will describe what caused you to fill out a report on the alleged victim. If anyone saw the incident happen, you will need to add their contact information to the Other Participant Section. Please answer as many of the following questions as you can.
What date did the incident occur?
:

Incident Details Incident Details















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Add Edit Delete
If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page. If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page.
Add Edit Delete
If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page. If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page.
Add Delete
If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page. If you selected the "Add" link button above and the page does not open, it is likely that your Pop Up Blockers are turned on. Please turn off the pop up blocker by accessing the Tools Menu -->Manage Pop Up Blocker. IF you are using Internet Explorer (IE) select the CTRL and ALT at the same time and then click on the "Add" link to open the page.

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