INCIDENT / ACCIDENT REPORT
Use this form to report any incident worth noting that occurs on your shift above and beyond the "normal course of duty". For example, you would use this form to document the details surrounding a call to emergency services to render aid. You would not use this form if you provided basic customer service such as providing a bandaid from your first-aid kit. If you are unsure if your incident is worth reporting, report it anyway.
Report Information
Name
*
First Name
Last Name
Email
*
example@example.com
Partner's Name (if applicable)
First Name
Last Name
Supervisor's Name
First Name
Last Name
Supervisor's Email
example@example.com
Department
*
Please Select
Event Security
Static Security
Mobile Patrol
Stage Crew
Parking
Incident Date
*
-
Month
-
Day
Year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Event / Shift Name
*
City
*
Please Select
Calgary
Edmonton
Other
Venue / Facility / Site Name
*
Specific location within venue / facility / site
*
example: 10m inside west door #6
Type of incident (check all that apply)
*
Ejection
Near Miss
Staff / workplace injury
Staff conduct
Serious incident
Fight / violence
Medical
Other
How would you rate the severity of this incident?
*
Minor
1
2
3
4
Severe
5
1 is Minor, 5 is Severe
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Incident Details
Please provide as much detail of the incident as possible, including any actions taken and by whom. Write down the facts surrounding the incident and your specific observations. Do not include your own conclusions, judgements, or speculation. Tip: you can use the voice dictation function of your device to make populating this information faster.
Please write your account of the incident in your own words. Be thorough and detailed. Use specific times.
*
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Description of involved individuals
Individual 1
Gender
*
Male
Female
Non-binary
Unsure
Ethnicity
*
White
Black
Indigenous
Asian
Middle Eastern / Arab
Latin American
Other
Age
*
Height
*
Build
*
Be descriptive. Example: slim, average, heavyset, muscular, etc.
Hair colour
*
Brown
Black
Blonde
Grey
Red
Other
Eye Colour
Brown
Green
Hazel
Blue
Other
Facial hair
Describe the facial hair of the individual, if any
Other identifying features
Tattoos, birthmarks, jewellery, etc.
Clothing description
*
Be detailed!
Upload a photo of this individual, if available
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Choose a file
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Are there more individuals involved?
*
Yes
No
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Description of involved individuals
Individual 2
Gender
*
Male
Female
Non-binary
Unsure
Ethnicity
*
White
Black
Indigenous
Asian
Middle Eastern / Arab
Latin American
Other
Age
*
Height
*
Build
*
Be descriptive. Example: slim, average, heavyset, muscular, etc.
Hair colour
*
Brown
Black
Blonde
Grey
Red
Other
Eye Colour
Brown
Green
Hazel
Blue
Other
Facial hair
Describe the facial hair of the individual, if any
Other identifying features
Tattoos, birthmarks, jewellery, etc.
Clothing description
*
Be detailed!
Upload a photo of this individual, if available
Browse Files
Drag and drop files here
Choose a file
Cancel
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Are there more individuals involved?
*
Yes
No
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Description of involved individuals
Individual 3
Gender
*
Male
Female
Non-binary
Unsure
Ethnicity
*
White
Black
Indigenous
Asian
Middle Eastern / Arab
Latin American
Other
Age
*
Height
*
Build
*
Be descriptive. Example: slim, average, heavyset, muscular, etc.
Hair colour
*
Brown
Black
Blonde
Grey
Red
Other
Eye Colour
Brown
Green
Hazel
Blue
Other
Facial hair
Describe the facial hair of the individual, if any
Other identifying features
Tattoos, birthmarks, jewellery, etc.
Clothing description
*
Be detailed!
Upload a photo of this individual, if available
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Are there more individuals involved?
*
Yes
No
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Description of involved individuals
Individual 4
Gender
*
Male
Female
Non-binary
Unsure
Ethnicity
*
White
Black
Indigenous
Asian
Middle Eastern / Arab
Latin American
Other
Age
*
Height
*
Build
*
Be descriptive. Example: slim, average, heavyset, muscular, etc.
Hair colour
*
Brown
Black
Blonde
Grey
Red
Other
Eye Colour
Brown
Green
Hazel
Blue
Other
Facial hair
Describe the facial hair of the individual, if any
Other identifying features
Tattoos, birthmarks, jewellery, etc.
Clothing description
*
Be detailed!
Upload a photo of this individual, if available
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Are there more individuals involved?
*
Yes
No
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Save
Description of involved individuals
Individual 5
Gender
*
Male
Female
Non-binary
Unsure
Ethnicity
*
White
Black
Indigenous
Asian
Middle Eastern / Arab
Latin American
Other
Age
*
Height
*
Build
*
Be descriptive. Example: slim, average, heavyset, muscular, etc.
Hair colour
*
Brown
Black
Blonde
Grey
Red
Other
Eye Colour
Brown
Green
Hazel
Blue
Other
Facial hair
Describe the facial hair of the individual, if any
Other identifying features
Tattoos, birthmarks, jewellery, etc.
Clothing description
*
Be detailed!
Upload a photo of this individual, if available
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Conclusion
Please include here any other details or information not already captured in the report.
Please upload any other relevant photos or documents related to this incident.
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I certify that all the information contained in this report is true to the best of my knowledge.
*
Please verify that you are human
*
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