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Incident Report

Please describe the event without using personal opinion or bias.
Example: "I think they deserved it." or "I don't like this person."
Please only state facts of which you are certain of.

Name of Employee Filing the Report

Date

First and Last Name of the Client

Was another client or staff member involved?

Time of Event

Date of Event

Address or Approximate Location of Event

Did this Event Violate One of the Big 4? (Police Involvement, AWOL, Criminal Activity, Alleged Abuse)

Additional Notes

Please describe the event in as much detail as possible as well as the effected people and effected areas if there are any injuries.

Photos

Please upload appropriate photos of injuries whether they are minor or major.