Incident Report

Choose type of incident/injury being reported

What This Category is for:

This category is strictly for losses or damages caused by unexpected, non-customer-related incidents affecting our physical property and assets.

Use this category ONLY for incidents involving:

Burglary or Break-ins: When unauthorized individuals (thieves) enter our secured property, storage yard, or building to steal equipment or inventory.

Vandalism: Intentional damage to our buildings, perimeter, vehicles, or equipment by external third parties.

External Property Damage (Accidental): Unforeseen events where external forces cause property damage.

Example: A vehicle driving down the road crashes into our gate or fence.

Example: A severe storm causes unexpected damage to a storage unit, resulting in equipment loss.

External Theft: Equipment that is stolen directly from a secured property without the involvement of a current or former customer.

What This Category IS NOT For (Internal/Customer-Related Issues)

DO NOT use this category for losses or damage that are part of the normal customer/rental cycle or internal errors. These incidents must be logged under separate, existing categories (e.g., "Customer Debt" or "Rental Non-Return").

Location submitting report*

Person writing report*

First NameLast Name

Person writing report email*

example@example.com

Location requesting write off of bad debt*

Person requesting write off of bad debt*

First NameLast Name

Customer Information*

Customer e-mail

example@example.com

Witness e-mail

example@example.com

Date of incident*

Date

Hour MinutesAM/PM Option

Date of injury*

Date

Hour MinutesAM/PM Option

IRO Weekly Review*

Location incident occurred*

Street Address

CityState / Province

Postal / Zip Code

Location injury occurred*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Detail where injury occured.*

e.g. concrete plant, work shop, on delivery, wash bay, propane tank, ect.

Detail type of injury that was sustained.*

e.g. right wrist, left elbow, lower right back, etc.

Customer(s) renting from All Star Rents*

Employee(s) involved in incident*

Customer phone number*

Phone Number

Has equipment been quarantined?*

YesNo

Equipment Involved*

Equipment used at time of injury

Person(s) injured*

Person(s) Injured Customer(s) & Employee(s)*

Did the injured receive medical treatment?

At what medical institution did they receive care?

Medical Facility

Street Address

CityState / Province

Postal / Zip Code

Please detail treatment

Please detail why treatment was not needed

Was a police report filed?

Agency incident was reported to

Please explain why no police report was filed

Employee was drug & alcohol tested on.

Date

Hour MinutesAM/PM Option

All Star Rents Manager or Supervisor statement

Describe the incident, in full detail (who, what, where, when, how, etc)

Employee involved in incident statement

Describe the incident, in full detail (who, what, where, when, how, etc)