INCIDENT REPORT FORM

REPORTED BY: DATE:

LOCATION OF INCIDENT:
Location :

Date of Incident:

Time:

TYPE OF INCIDENT:
(guest injury, personal property damage, theft, restaurant property damage, other):

DESCRIPTION OF INCIDENT/PROPERTY DAMAGE:

AUTHORITIES CONTACTED :
GUEST NAME/CONTACT INFORMATION:
Last, first:
Email:
Phone/cell:

PREPARED BY WITNESSESS ACKNOWLEDGES

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FOR MANAGEMENT
ACKNOWLEDGED COST CONTROL

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