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Incident Report

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  • View Previous Incident Reports

Report Incident


OCCURRENCE REPORTS ARE REQUIRED FOR THE FOLLOWING:
  • (Listed as examples, only) Flooding, water damage or water disruption, injury to customers, comments by customers or nearby businesses, receipt of goods, equipment or fixtures, with shipping damage, fire, security violations, & employee Injuries. The general rule is, “when in doubt, fill one out”.

  • Incident Involves:
  • Location of the Occurrence
  • Did the incident occur: Indoors Outdoors
  • Where specifically?
  • Describe the incident in detail:
  • Please provide a copy of the signed waiver.
  • Were there any witnesses? Yes No
  • Are you able to secure statements from the witnesses? Yes No
  • Please provide copy of the statements
  • Do you have videos of the incident?
    Yes No Please provide us with a copy of the video.
  • Who were the people involved? (Complete all information below)
  • A. Full Name:
  • Age:
  • Gender:
  • How Involved?:
  • Address:
  • Phone Number:
  • Email Address:


  • B. Full Name:
  • Age:
  • Gender:
  • How Involved?:
  • Address:
  • Phone Number:
  • Email Address:


  • C. Full Name:
  • Age:
  • Gender:
  • How Involved?
  • Address:
  • Phone Number:
  • Email Address:
  • Did this incident involve an injury or an illness?
  •