GUEST/EMPLOYEE INCIDENT FORM
Date of Incident
-
Month
-
Day
Year
Time of Incident
*
Hours Minutes
AM
PM
AM/PM Option
Valet or Transportation
*
Please Select
Valet
Transportation
Print Name of Guest/Employee
*
First Name
Last Name
Phone Number of Guest/Employee
*
Email of Guest/Employee
*
example@example.com
Location of Incident:
*
Be detailed
Details of Incident:
*
Were there any Injuries?
*
Yes
No
What are the Details of the Injury:
Was there damage to a vehicle?
*
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?
Witness Name #1
First Name
Last Name
Witness Phone Number
Witness Name #2
First Name
Last Name
Witness Phone Number
Guest/Employee Signature:
*
Date of Guest/Employee Signature
-
Month
-
Day
Year
Date
Manager/Lead Signature:
Date of Manager/Lead Signature:
-
Month
-
Day
Year
Date
Submit
Should be Empty: