Leadership and Management: General Incident Report

Leadership and Management: General Incident Report
BSM encourages all managers and leaders to resolve any problem or issue directly with the individuals involved. If your team has a concern or experience a problem that needs to be documented, we ask that you have a conversation and complete this form within two working days after the incident or problem occurs.

The questions in this form should act as a guide for the conversation. If you would like for the HR Manager to be part of the conversation with the employee involved in the incident, or to help you plan the conversation, please reach out to hr@bsmny.org prior to that conversation. After reviewing the form, HR will reach out to provide next steps for resolution or gather further documentation within 24 hours (Monday-Friday).
Your Name
Your Job Title
Employee 1 involved in incident*
Employee 1 Job Title*
Employee 2 involved in incident*
Employee 2 Job Title*
Date/Time of Incident

MonthDayYear
Date
Location of Incident
Description of the incident (What happened during the incident?):
Witnesses to Incident (Did anyone else who you haven’t yet mentioned witness the incident?)
Actions taken so far (Did the person reporting and other people involved take any actions towards mediation already? If yes, please describe:
Is there any other information you feel is relevant to this situation? (Supervisors and Managers may need to ask clarifying questions throughout an investigation, please capture those questions and the responses here)
Did the reporting employee notify you of any specific requests or questions?
What ideas do you have for remedying the situation?
Is there any other information you feel is relevant to this situation?
Upload relevant documentation to this incident.

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Your Signature

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Date

MonthDayYear
Date
Should be Empty: