27 GWR Incident Report

• 27 Great West Road Incident Report

• 

• Incident Report Number:

• Type of Incident:

• Location:

• Reported by:

• Date and Time of Incident:

  Date

Incident Details

• What incident has occurred?

  Select Slips, Trips or Falls Lift Issue Theft Road Traffic Accident Vehicle/Property Damage Fire System Suspicious Vehicles Suspicious Persons Visitor Disturbance Other

  • Slips, Trips or Falls
  • Lift Issue
  • Theft
  • Road Traffic Accident
  • Vehicle/Property Damage
  • Fire System
  • Suspicious Vehicles
  • Suspicious Persons
  • Visitor Disturbance
  • Other

• Pictures of Incident:

  Media

• Enter Details of Incident

• Were there any witnesses to the incident?

  Yes

  No

  N/A

• Compile Witness Statements

• Are witness statements complete?

  Yes

  No

  N/A

• What is the issue

  Entrapment

  Breakdown

  Other

• Enter details of incident

Notifications

• Has the FM Team been informed

  Yes, By Phone Call

  Yes, By Email (response received)

  No, Left Voicemail

  No, Email response not received

• Has the 27 Great West Road and G4S escalation process been followed?

  Yes

  No

• Have you signed the DOB in Red Ink?

  Yes

  No

• Has the sites incident report been Signed in Red Ink?

  Yes

  No

• Follow up Actions if required:

• Has this incident been noted in the Handover?

  Yes

  No

  N/A

• Add to the handover and tick the box to confirm attachment in the handover

• Incident Resolved?

  Yes

  No

• By completing this document and signing the below section you are confirming that all the information provided in the previous sections is of a true and accurate nature, should the information be false you may face disciplinary action.

• By ticking this box you are confirming that you have read and understood the information above.

• By ticking this box you are confirming that the information that you have recorded is a true and accurate reflection of the events that have transpired.

• To be signed by the officer completing the report

  Sign