Security Incident Report Form

A security incident report form is used to gather information about an incident that is deemed to pose risk to an individual or property and requires the action of law enforcement authorities. The form is filled out by the person involved in the incident. Shown below is a sample security incident report form.

Sample Security Incident Report Form

Date of incident __________________

Time ________________________

Country Department reporting incident __________________

Location of incident ______________________________

Physical address of incident __________________________________

Act of violence ___________________________

Responding law enforcement agency ___________________

Law enforcement report number _______________________

Summary of incident _______________________

Describe the incident

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Names and contacts of others involved

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Reported by ___________________________ Phone ____________

Manager ______________________________ Phone _____________

Date of notification ______________________

Time of notification _______________________

Law enforcement ________________________

Safety plan _____________________________

Event log of incident initiated and maintained by ____________________________

Other actions taken ________________________________________________________________________________________________________________________________________________

Department manager __________________________ Phone _____________________

Category: Report Forms