Incident Report (guests/employees)
Incident Location
*
101 - Milford
102 - Kingston
104 - New Hartford
105 - Portsmouth
106 - Mt Pleasant
Injured Parties Name
*
Date of Incident
*
-
Month
-
Day
Year
Date
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
Employees Working at Time of Incident (list each name in their department, followed by comma)
*
Your Statement (be very detailed)
*
POS System Check #
Did they have a guest check with pinz? What was the check #?
Follow-up (what happened next)
*
Did they go back to bowling? Arcade? Work (emnployee)? Did they go home? Did they go to the hospital? What was the conclusion?
Manager Submitting Incident Report
*
Attach Incident Report
*
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Attach pictures (if necessary)
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