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623-266-8747
1175 E. Lone Cactus Dr. Phoenix, AZ 85024
[email protected]
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Chateau Luxe Event Venue
Top Phoenix Event Venues, Indoor & Outdoor Space for Corporate, Weddings, and other events
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Incident Report
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Incident Report
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
*
First
Last
Reporting employee's email
*
Witness Employee's name (if any)
First
Last
About Incident
Date & Time of incident
*
Date
Time
What is the nature of the incident?
*
Staff or Contractor Injury
Guest/Vendor Injury
Inappropriate Behavior
Theft
Damage to Company Property
Harassment
Violation of Company Policy
Other (Describe Below)
Please describe the incident in detail
*
Please provide as much detail as possible about this incident including times, locations, and who was present.
Was Police/Fire/EMT required?
*
Yes
No
Was Chateau Luxe Security contacted at the time of this incident?
*
Yes
No
#1 Name of person involved in this incident
*
First
Last
#2 Name of person involved in this incident
First
Last
#3 Name of person involved in this incident
First
Last
#4 Name of person involved in this incident
First
Last
If there were additional people involved, list them below along with any other additional details you wish to share.
Visual
Text
If applicable, upload any photos related to the incident here
Click or drag files to this area to upload.
You can upload up to 5 files.
Max file size = 5mb
Signature of Employee completing this incident report
*
Clear Signature
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