• Manager Incident Report

  • Reporting Employee

    Take care of customer/employee. Notify Manager on duty according to policy. Complete incident report. Photograph the area of the incident. Capture video of the incident.

    Manager on Duty

    Reference call card if injury/ilness or damage. Call police if property damage or 911 if needed for injury. Submit this incident report ASAP. If you need to send other correspondence send to INCIDENTS@stromainoil.com. Employee injury-MANAGER must call HR before employee clocks out

     

  • Date of Report*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of Incident*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Incident*
  • How were you (the Manager) contacted?*
  • When were you contacted (date & time)?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • What type of incident are you reporting?*
  • Information of Person involved: (Put NA if unknown or not applicable.)*
  • Was a second Person involved?*
  • Information of 2nd Person involved: (Put NA if unknown or not applicable.)*
  • Is this person requesting that home office contact them?*
  • Injury Details: (Put NA if unknown or not applicable.)*
  • Did an employee offer any help?*
  • If you phoned someone as requested for the injured party, please answer: (Put NA if unknown or not applicable.)*
  • Please list any NON-EMPLOYEE Witnesses involved (if applicable):
  • Is it possible the incident was caught on video?*
  • Did you review the video?*
  • Does the video match the incident report?*
  • Please list camera names and times (if applicable):
    Rows
  • Have all team members, who witnessed the incident, submitted incident reports? (If yes, make sure to attach at the end.)*
  • Has this incident been resolved?*
  • Could this incident have been prevented/avoided?*
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  • Date Signed:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: