Incident Report Form
CL Staff to complete this form for any incidents involving injuries, security issues, or other incidents which must be formally recorded. Be sure to collect contact information of any person(s) who are injured on the property including FULL NAME, PHONE #. Incident reports are confidential.
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Person Completing This Form:

Reporting Employee name
Witness Employee's name (if any)
Other Witness Name (if any)

About Incident

Date & Time of incident
Please be as close to the time as possible so that we can locate surveillance footage of the incident if needed.
BE SPECIFIC - (i.e. in lobby near the front glass doors)
What is the nature of the incident?
Did you ask the individual if they wanted medical care from 911?
Please provide as much detail as possible about this incident including times, locations, and who was present, and what happened. Please provide step by step details about any actions taken by you or other CL staff.
Was Police/Fire/EMT required?
Was Chateau Luxe Security contacted at the time of this incident?
Was the Chateau Luxe Manager on Duty contacted at the time of this incident?
#1 Name of person involved in this incident
#2 Name of person involved in this incident
#3 Name of person involved in this incident
#4 Name of person involved in this incident
If there were additional people involved, list them below along with any other additional details you wish to share.
Click or drag files to this area to upload. You can upload up to 5 files.
Max file size = 5mb
Click or drag files to this area to upload. You can upload up to 5 files.
Max file size = 5mb
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