Security Incident Report

Security Incident Report Form
Reported By
Gavin Easley
Date of Report
March 1, 2024
Title/Role
GSOC Operator
Incident No.
123456
Incident Information
Incident Type
Employee Injury on Premisses
Date of Incident
December 1, 2023
Specific Place of Location
Stairwell A, Seventh Floor, Warrenton Building
Location of the Incident
800 Freedom Ln.
Arlington County, Arlington , 22042
Scope of the Incident
Medium
Incident Description
On Tuesday, 12/01/2023 at 09:31, a call was received from Nick Oftyme indicating that he located Anita Stretcher in stairwell A on the seventh floor of the Warrenton building. Ms. Stretcher was found sitting immobilized due to an ankle injury that she had recently sustained from falling down the stairs. She informed Mr. Oftyme that she had only tripped on the last few stairs and thus was able to support herself with her hands while falling to avoid further injury. Mr. Oftyme stated that Ms. Stretcher’s ankle was visibly swollen and that she was unable to walk. Immediately following Mr. Oftyme’s report, the on-site guard Al Beether was contacted via Slack to request that he report to the scene. Officer Beether indicated that he was near the scene and that he could report there immediately. Mr. Oftyme then stated that he will remain at the scene until officer Beether arrives. At 09:35, 9-1-1 was called to report the incident and request emergency medical assistance. The dispatcher stated that an ambulance will arrive shortly. At 09:39, officer Beether relayed his report from the scene via slack. He indicated that although Ms. Stretcher was unable to walk, the scene was indeed safe. Officer Beether remained with Ms. Stretcher until emergency responders arrived on scene at 09:43, at which point she was transported to the Valley Hospital Center located at 873 Smithton Road.
Contact Involved
(555) 555-5555
People Involved
Anita Stretcher
Other Witn
esses
Nick Oftyme
Contact Wi
tness
(765) 432-111
1
Supervisor Name
Gavin Easley
Date
March 1, 2024
Signature
Item - signature 0
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About this template

A security incident report is a document used by a business owner or police officer to report and document an incident. Whether you work in law enforcement, a university or college, or you simply run a small business, a report of security incidents is an important way to make sure your company is protected. Use this Security Incident Report template to document the details of a security incident to make sure your property is safe and secure.

Fill out the Security Incident Report template on your computer and send it to the police. Or you can use Jotform to collect contact info from witnesses, like their name, phone number, and email address, and then forward it to the appropriate law enforcement department or authority. Fully customize this template, add more question fields, and change the fonts, colors, margins, and backgrounds without a single line of coding required. You can even print out created reports for victims of a crime, or store them in your other accounts. Keep your company protected with a free Security Incident Report template.

Categories
Details
4,697 Clone
Created by
luiswilliams
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