INCIDENT LOG

Date:

Incident Number Patron’s Name /

Action Taken Reason Patron Departure Initials
And Time Description
__ ID checked __ No ID __ Left alone __ Police
1. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
2. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
3. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
4. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
Additional Notes:

ACCIDENT/INJURIES
Incident Number Part of Body Reason Injury Description of
Action Taken Initials
and Time Injured Incurred Incident
__ Refused Assistance
__ Administered First Aid
__ Phoned Ambulance
__ Phoned Police
1. Time:
__ Completed Incident Reports
__ Reviewed Incident with Manager
__ a.m. __ p.m. __ Notified Lawyer
__ Notified Insurance Company
__ Other:
____________________
__ Refused Assistance
__ Administered First Aid
__ Phoned Ambulance
__ Phoned Police
2. Time: __ Completed Incident Reports
__ Reviewed Incident with
__ a.m. __ p.m. Manager
__ Notified Lawyer
__ Notified Insurance Company
__ Other:
____________________

Follow-up/Recommendations:

Supervisor’s Signature Date

Tourism Saskatchewan gratefully acknowledes Alberta Gaming, Liquor and Cannabis Commission for providing the source for this document.
 INCIDENT LOG
Date:

Incident Number Patron’s Name /

Action Taken Reason Patron Departure Initials
And Time Description
__ ID checked __ No ID __ Left alone __ Police
1. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
2. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
3. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
__ ID checked __ No ID __ Left alone __ Police
4. Time: __ Refused service __ Minor __ Taxi __ Unknown
__ Cut off service __ Intoxicated __ Left with friends
__ a.m. __ p.m. __ Ejected from __ Other: __ Other:
premises ____________________
Additional Notes:

ACCIDENT/INJURIES
Incident Number Part of Body Reason Injury Description of
Action Taken Initials
and Time Injured Incurred Incident
__ Refused Assistance
__ Administered First Aid
__ Phoned Ambulance
__ Phoned Police
1. Time:
__ Completed Incident Reports
__ Reviewed Incident with Manager
__ a.m. __ p.m. __ Notified Lawyer
__ Notified Insurance Company
__ Other:
____________________
__ Refused Assistance
__ Administered First Aid
__ Phoned Ambulance
__ Phoned Police
2. Time: __ Completed Incident Reports
__ Reviewed Incident with
__ a.m. __ p.m. Manager
__ Notified Lawyer
__ Notified Insurance Company
__ Other:
____________________

Follow-up/Recommendations:

Supervisor’s Signature Date

Tourism Saskatchewan gratefully acknowledes Alberta Gaming, Liquor and Cannabis Commission for providing the source for this document.