INCIDENT REPORT

Use this form to report accidents, injuries, medical situations and/or behavioral incidents.  Incidents involving crimes or traffic accidents should be reported to the police at #911. This incident report should be submitted to the Managing or Hospitality Director.  

INFORMATION ABOUT PERSON(S) INVOLVED IN INCIDENT
Date *
Date
Name *
Name
Address *
Address
Phone *
Phone
INFORMATION REGARDING THE INCIDENT
Date 1 *
Date 1
Time
Time
Police Notified?
What happened, how it happened, factors leading to event, etc. Be as specific as possible.
Were there witnesses to this incident? *
Names, Phone Numbers, Emails, Etc
Was the individual injured? *
(laceration, sprain, etc.), the part of body injured, and any additional information about the resulting injury(ies):
Was medical treatment provided?
If yes, where was treatment provided:
REPORTER INFORMATION
Date 2
Date 2
Phone 1 *
Phone 1