Barrier Incident Report

• Reference No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date and time of Incident

  Date

• Was the Incident Reported?

  Yes

  No

  N/A

• Date and Time The Incident was Reported.

  Date

• IF PERSON WAS ENTERING CENTRE GO TO POINT 1

• IF PERSON WAS LEAVING THE CENTRE GO TO POINT 2

Point 1.

• Point 1. person ENTERING the premises

• If so which entrance?

• Did the person have a ticket when the barrier incident occurred?

  Yes

  No

  N/A

Point 2.

• Point 2. Person Exiting the premises

• If so which exit?

• Did the person have a ticket when the barrier incident occurred?

  Yes

  No

  N/A

• Details of the Incident.

• Has the barrier shown a fault which would have caused the Incident? If YES, please complete description of fault.

  Yes

  No

  N/A

• Description of Fault:

• Was there Damage to the Vehicle?

  Yes

  No

  N/A

• Description of Damage:

• Was there Damage to Centre property?

  Yes

  No

  N/A

• Description of Damage:

• Weather conditions:

• Tyre condition (WORN/GOOD)

• Vehicle Registration No.

• Make & Model of Car:

• Name, Address & Contact No. Of Driver

• Signature of person making the report

  Sign

• Signature of Centre Manager

  Sign

• Photos

  Media

TO BE COMPLETED BY CENTRE MANAGER ONLY.

• Was video evidence available?

  Yes

  No

  N/A

• What does the CCTV Footage show?