Seven Hospitality - Guest Incident Report
This form is for Non-Team Member incidents, accidents or injuries (enter NA in field for items not applicable)
Guest Information
Guest Name
*
First Name
Last Name
Sex
*
Female
Male
Guest Phone Number
*
-
Area Code
Phone Number
Guests E-mail
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Guest Incident Information
Date of Incident
*
-
Month
-
Day
Year
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Time of Incident
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Was the Guest Dining in the Restaurant?
*
Yes
No
Where exactly did the incident Occur in the restaurant?
*
Describe in Detail What Happened
*
What Specific Body Part(s) Where Injured (if applicable)
*
Be Specific (ex: Left Hand, Index Finger)
List anyone that witnessed the Incident or injury
*
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Treatment Provided
If Applicable
Was The Guest Taken for Medical Care
*
No Medical Treatment
Minor Treatment by Employer/Other Team Member
Minor Treatment by Clinic, Urgent Care or Doctor
Emergency Room Care
Hospitalized > 24Hrs
Future Major Medical Anticipated
How Was The Guest Transported To Medical Care
*
By Manager/Family/Ambulance/Other Team member (name), etc
Name of Medical Center/Provider and Address
*
What Medical Treatment Was Provided if Known?
*
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GUEST INCIDENT REPORT BY
S E V E N H O S P I T A L I T Y
Name of Manager Completing This Incident Report
*
First Name
Last Name
Date of Report
*
-
Month
-
Day
Year
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Your Email Address
*
Upload Scan Files of Any Medical Receipts, Documents, Reports or Photos
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