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Incident Report
Sometimes things go wrong and other times they go really wrong. When they do, this Incident Report and it's detail will be the very thing that we use to learn what happened and what we could have done better.
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Questions
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1
Incident ID
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2
Reported By
*
This field is required.
Full name of the person completing this form (that's you ;))
First Name
Last Name
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3
Tags
*
This field is required.
Please check all that apply.
Theft
Unauthorized Access
Member Safety
Employee Safety
Drugs
Physical Violence
Threats
Facility Damage
Other
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4
Incident Date
*
This field is required.
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Date
Year
Month
Day
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5
Incident Time
*
This field is required.
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Minutes
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6
Subject
A short summary of this incident.
Subject
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7
Members Involved
*
This field is required.
List all the numbers and member numbers for Members involved in the incident .
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8
Incident Report
*
This field is required.
Remember, we have a duty to be honest, fair and understand of ALL our members. We depend on the integrity of our staff to make this possible.
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9
Documentation
Pictures of damage, Persons of interest, SPD business cards, etc. Anything that documents this incident for the management to consider.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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10
External Involvement
Did any other organizations or people outside of Z respond to the incident?
SPD (Seattle Police Department)
Emergency Medical Services
SFD (Seattle Fire Department)
Another local business
Health Department
Seattle City
Other
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11
SPD Case Number
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12
Integrity
*
This field is required.
I have been fair, truthful and accurate to all members and employees mentioned in this report.
YES
NO
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13
Signature
*
This field is required.
Clear
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14
Manager Notes
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