Incident Report Company Name Employee Name Employee Title Date of Incident Incident Type AccidentAssaultFireTheftOther How the event occurred List any witnesses to the event (is any video available?) Were there any safety or security violations that contributed to this Incident List what losses or damages occurred List any bodily injuries If a vehicle accidentIs the vehicle now drivable? YesNo When was the Incident reported? To whom was the Incident reported: List claim details if an insurance claim will be filed Attach any image or PDF that is relevant to this Incident