Incident Report

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Reporting Employee name *

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Reporting employee's email *

Witness Employee's name (if any)

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Last

Date & Time of incident *

Date

Time

What is the nature of the incident? *

Please describe the incident in detail *

Please provide as much detail as possible including times, locations, and who was present.

Was Police/Fire/EMT required? *

Did Chateau Luxe Security respond to this incident? *

#1 Name of person involved in this incident *

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Last

#2 Name of person involved in this incident

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Last

#3 Name of person involved in this incident

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Last

#4 Name of person involved in this incident

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Last

If there were additional people involved, list them below along with any other additional details you wish to share.

Signature of Employee completing this incident report *

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