Incident Report Form Template


Whenever an adverse incident occurs, it is important to report it in order to prevent it from happening to someone else in the future. An incident report form can be used in instances when one is faced by aggressive behavior, destroyed property, physical and verbal abuse. This incident report form template can be used for such incidents.

Sample Incident Report Form Template

Name ………………………………..

Title ………………………………….

Date …………………………………

Time …………………………………

Incident Location …………………………….

Reference Number ……………………………..

Were the police informed of the incident?

………………………………………………………………..

Would you like to speak further with the police?

……………………………………………………………………

What sequence of events led to the incident?

………………………………………………………………………………………………

Were there other people present during the incident?

…………………………………………………………………………………..

If yes, please name them ……………………………………………………………….

Perpetrator’s Name …………………………………………

Description of Perpetrator …………………………………..

Describe the Incident ………………………………………………….

Was anyone injured during the incident?

……………………………………………………………………

What types of injuries were sustained?

…………………………………………………….

Who was injured?

……………………………………………..

Was any form of treatment given to the injured person?

…………………………………………………………………………….

What caused the incident?

…………………………………………………………………………………


Category: Report Forms

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