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Be as specific as possible and include the “W’s” Who was involved and were there any

Witnesses? What exactly happened? When did the incident happen? Where did the incident
occur? Obtain names, addresses and phone number. Remember only to report on facts! No
more- no less. Good rule of thumb is to remember is that this Incident Report might be seen by
a judge and jury and could become evidence in a trial.

SIMPLE INCIDENT REPORT

Name of Reporting Security Officer:

Date of Incident: Time of Incident:

Location of Incident:

Assisted by:

Details of Incident: (Use additional sheets as needed and attach any sketches or diagrams)
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Notified: ( ) Police ( ) Fire ( ) Ambulance ( ) Other:

Time Above Notified Arrived: AM/PM Left at: AM/PM

Incident Report Submitted to: Date/Time:

Signature of Officer:

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