GUEST/EMPLOYEE INCIDENT
Date of Incident
-
Month
-
Day
Year
Time of Incident
*
Hours Minutes
AM
PM
AM/PM Option
Please note that the person who should be filling out this report should either be the onsite Lead or preferable the person who was involved in the incident.
Is the person filling out this form directly involved in the incident? (This section is for the individual’s details, not for information related to others involved in the incident.)
*
Yes
No
Who is the Directly Involved Party? (write "N/A" if there wasn't anyone)
*
First Name - Last Name
What is their Phone Number? (write all "0" if there wasn't anyone)
*
Format: (000) 000-0000.
Valet/Guest Information
Whoever is filling this form out
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Guest/Employee Signature:
*
Date of Guest/Employee Signature
-
Month
-
Day
Year
Date
Second Party Information
This should contain the details of the party involved in the incident, such as the vehicle owner's information if a valet damages a car.
Name of Guest/Employee Involved in the Incident
First Name
Last Name
Phone Number of Guest/Employee
Format: (000) 000-0000.
Email of Guest/Employee
example@example.com
Location of Incident:
Be detailed. Address and a specific description of the area are preferred.
Details of Incident:
*
Include details that will help provide a clearer picture of the incident.
Were there any Injuries?
*
Yes
No
What are the Details of the Injury:
Be specific and very detailed if possible
Was there damage to a vehicle? If yes please take photos
*
Yes
No
Were pictures taken of damage?
Yes
No
Upload Photos of the Damage
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Was Emergency Services Contacted, if so Who?
*
Was Anyone Notified of the Incident?
*
Yes
No
Who?
Witnesses should be individuals who directly observed the incident.
Witness Name #1
First Name
Last Name
Witness Phone Number
Format: (000) 000-0000.
Witness Name #2
First Name
Last Name
Witness Phone Number
Format: (000) 000-0000.
Onsite Manager/Lead Signature:
Date of Onsite Manager/Lead Signature:
-
Month
-
Day
Year
Date
Submit
Should be Empty: