Title Page
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Conducted on
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Prepared by
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Location
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Crime Ref No
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Name of Police Officer in Attendance
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Insurance Broker: Darwin Clayton,
Darclay House
9 Vernon Avenue
Beeston
Nottingham, NG9 2NS
T: 01892 511 144
F: 01892 511 455
info@dcuk.co.uk
Incident Details
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Name of person involved in incident
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Incident investigation team (Site rep, Lingwood rep etc.)
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What task was being performed at the time of the incident
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What happened? (e.g.injury, theft, vandalism etc')
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Take photo evidence of incident
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List of equipment damaged, stolen
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Take photo evidence of surrounding environment (fence breaches, cabin damage, padlocks snapped, injuries etc.)
Immediate / Root Cause
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Are there any obvious signs i.e. gates not locked, poor housekeeping, equipment not locked etc.
Contributing Factors
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Select all the relevant contributing factors for each of the categories below.
To create a corrective action click on the "Action" button, enter description of what we going to do to fix the problem, assign a due date, priority and person responsible. -
Environmental factors (weather, lighting conditions, noise etc.)
- Noise
- Lighting
- Weather
- Uneven Ground
- Items away from guard location
- Fencing Breached
- Buildings / Cabins Breached
- Lack of security awareness by client
- Other
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Security staff inducted to site (photo of induction record required from site security folder)
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Event log completed correctly (i.e. patrol times logged, site equipment listed, check calls recorded etc.) Photo of event log required
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Seperate statement from guard required
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Any other contributing factors (i.e. site restrictions, excavations, secondary site etc.)
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Take photo evidence of any contributing factors
Preventative Measures Going Forward (Recommendations)
Sign off
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Person involved in the incident
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Supervisor
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Site Rep
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Lingwood Mgnr
