GENERAL LIABILITY INCIDENT REPORT FORM

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If someone slips-and-falls in the community's common areas or parking lot, fill out our incident report form. Then use this form and fill out the answers to questions 1 through 8 and return both forms to the management office.

For Slip-and-Fall Accidents
Name of Injured Person:

First NameLast Name
Address of Injured Person:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Insured Person:
Resident?
example@example.com
Visitor?

YesNo
Take a photograph of the slip-and-fall site. Attach the photo to this jot form.
2. How well maintained was the slip-and-fall area at the time of accident:
(measure the depression, bump, hole, or defect with a ruler. Take a photograph of the ruler next to the defect to show its size. Also attach photo to this jot form.
3. Was there any debris on the ground next to the slip-and-fall site?

YesNo
If yes, explain:
4. Did the accident occur indoors or outdoors?
If outdoors, describe the weather conditions and where the incident occurred:
5. How crowded was the slip-and-fall site at the time of accident?
6. Is the slip-and-fall site heavily trafficked?

YesNo
7. What is the state of repair of the slip-and-fall site (look at the area around the slip-and-fall site and state if the area is well maintained or if it is in disrepair):
8. Was there an alternative, less hazardous route the person could have taken?

YesNo

Phone Number:

First NameLast Name
Email:
example@example.com
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INCIDENT INFORMATION - GENERAL LIABILITY