Incident Record

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Incident Type

  Select Pest Infestation HVAC Structural Customer Injury Fire Flood Store Not Trading

  • Pest Infestation
  • HVAC
  • Structural
  • Customer Injury
  • Fire
  • Flood
  • Store Not Trading

• Health & Safety Risk

  Yes

  No

  N/A

• Severity

  High

  Medium

  Low

Description of Incident

• Description

• Incident photos

  Media

Actions Taken

• 1. Actions Notes

• Date & Time action taken

  Date

• 2. Action Notes

• Date & Time action taken

  Date

• 3. Action Notes

• Date & Time action taken

  Date

• 4. Action Notes

• Date & Time action taken

  Date

Escalation Route

• Does this require to be escalated to Senior Manager

  Yes

  No

  N/A

• Escalate to

  Select N/A Audrey Gibson Mike Erwin Sandra White Peter Gilchrist Patrick Dunne

  • N/A
  • Audrey Gibson
  • Mike Erwin
  • Sandra White
  • Peter Gilchrist
  • Patrick Dunne

Signature

• StoreCare Field Manager

  Sign

• Store Manager/Assistant

  Sign