Incident Report

1 Basic Information

Business / Property *

Reported By * Loading employees…

Position

Incident Date *

Incident Time

Report Date

Status NewUnder ReviewFollow-Up RequiredResolvedClosed

2 Location Details

Specific Area *

Other Area

Exact Location Description

3 Classification

Incident Type * Select type Customer ComplaintVerbal AltercationPhysical Altercation Security RemovalSlip / FallEmployee Injury Property DamageTheftHarassment Intoxicated CustomerMedical Emergency Police / Fire / Medical CalledCash Handling Issue Policy ViolationOther

Severity LowMediumHighCritical

Other Incident Type

Contributing Factors

Other Contributing Factor

4 People Involved

Staff Involved

Select staff member

+ Add

Customers Involved

Type customer names and contact info.

+ Add Customer

Witnesses

Type witness names and contact info.

+ Add Witness

5 Incident Narrative

What Happened? *

Actions Taken

Other Action Taken

Action Taken Notes

6 Authorities Contacted

Yes No

Police

Yes No

Officer Name

Badge #

Report #

EMS

Yes No

EMS Unit #

Hospital Transported To

Fire Department

Yes No

Fire Unit #

Reason

7 Injuries / Medical Attention

Yes No

Injury Description

Medical Attention

8 Property Damage

Yes No

Damage Description

Estimated Cost

Photos Taken NoYes

9 Incident Resolution

Final Outcome

10 Attachments

Attach evidence or supporting files

Photos, videos, PDFs, written statements, police reports, medical documents, or receipts.

11 Instructions for Human Resources

HR Instructions & Recommended Actions