Incident Report Template –

Bridge Hotel

This form is to be completed in the event of an incident or emergency.

Details of incident

Date: 15/2 /2024 Time: 11am Location: Hotel

Name of person/s John Doe (Hotel Guest)

involved in incident:

Location of incident: Lobby

Provide details of the incident.

Guest John Doe slipped on a wet floor near the lobby entrance.

Describe any injuries.

John sustained a minor bruise on his left arm.

Outline actions taken as applicable.

Hotel staff immediately assisted John to a nearby chair, provided a first aid kit, and informed the
cleaning staff to address the wet floor.

Describe hazards that may have contributed to or caused the injury.

Wet floor due to recent rain, lack of warning signs.

Other notes and comments.

Witnesses reported that John was in a hurry and may not have noticed the wet floor.

Signature of person
completing report:

Print name: Date:

© Pakenham Institute Pty Ltd |RTO No. 41536 l CRICOS Code: 03941H I Website: www.pakenham.edu.au
Unit 2, 66 – 68, Main Street Pakenham VIC 3810 Australia |Phone: 0432 197 654 |Email: admission@pakenham.edu.au
Student Resources for SITXCOM010 | v1.0 | Last reviewed: Jan 2023 | Not controlled when printed Page1 of 1