Legislative Walkout Absence Report Form
Use this form to report and document a legislative absence related to a walkout, including event details, reason, notice, impact, and supporting information.
Reporter and Member Details
Reporting Person Name
*
First Name
Middle Name
Last Name
Role / Title
*
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Legislator / Member Name Reported
*
Absence and Walkout Event Details
Legislative Body or Session Name
*
Date of Walkout or Absence
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time
Hour Minutes
AM
PM
AM/PM Option
End Time
Hour Minutes
AM
PM
AM/PM Option
Duration Missed (Minutes)
Location or Venue
*
Agenda Item(s) or Vote(s) Missed
Reason for Absence
*
Walkout
Protest
Boycott
Other
Reason, Notice, and Impact
Reported reason for absence or walkout
*
Was prior notice given?
*
Yes
No
Who was notified?
How did the absence affect proceedings, quorum, or decision-making?
*
Type of absence
*
Individual absence
Part of a group walkout
Supporting Information and Follow-Up
Supporting Notes or Incident Details
Attachments or Evidence
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Follow-Up Status
*
Please Select
Pending Review
Verified
Needs Follow-Up
Closed
Internal Reference Number or Case ID
Submit Report
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