Incident Report Form
CL Staff to complete this form for any incidents involving injuries, security issues, or other incidents which must be formally recorded. Incident reports are confidential.
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Person Completing This Form:

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

About Incident

Date & Time of incident
What is the nature of the incident?
Please provide as much detail as possible about this incident including times, locations, and who was present.
Was Police/Fire/EMT required?
Was Chateau Luxe Security 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
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